Dark knuckles can be a major cause of concern to some people. Different factors such as environmental conditions, some diseases and lifestyle changes are believed to contribute to this condition. 

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Here are the possible causes of dark knuckles according to Shilpa Amin, MD, CAQ, FAAFP, an emergency medicine physician in Orange Park, Florida.

1. Vitamin B12 deficiency

Common symptoms of this deficiency include fatigue, anaemia, shortness of breath and feeling queasy. However, this is not always the case. Dark knuckles can also indicate that you need to eat food laced with vitamin B12. 

 2. Drug reactions

Many drugs usually come with side effects. Some drugs have been linked to this condition. These drugs include oral contraceptive pills, growth hormone therapy, protease inhibitors and injected insulin. 

3. Dermatomyositis

This disease is characterised by skin rashes and muscle weaknesses. Normally, the rashes appear or manifest themselves on the knuckles and also on the elbows and some parts of the face. 

4. Prediabetes and diabetes

Dark knuckles are common in people suffering from diabetes. They can also be a warning sign that your blood sugar levels are high. Ensure you see a doctor in order to establish the actual cause of the dark knuckles.