Knuckle pads are hyperkeratotic, benign skin lesions that we commonly observe in obese patients. There is no study that investigates the association between metabolic syndrome (MetS) and knuckle pads. We aimed to investigate the frequency of MetS in patients with knuckle pads. Forty-seven patients with knuckle pads and 46 age- and sex-matched controls were enrolled. The presence of MetS was evaluated according to National Cholesterol Education Program-Adult Treatment Panel III criteria. In the patient group, waist circumference (P < 0.01), body mass index (BMI; P < 0.01), and systolic (P < 0.01) and diastolic blood pressure (P < 0.01) were higher than controls, and most of the patients had a history of hypertension (P < 0.01). The presence of MetS was found in 66% of the patients with knuckle pads and in 52.2% of the controls (P = 0.25). In the patient group, compared with controls, more patients had blood pressure above reference values or were on antihypertensive therapy (70.2% and 43.5%, P = 0.017, respectively), and had greater waist circumference value (93.6% and 76.1%, P = 0.038, respectively). The presence of the other three criteria were similar in both groups. Although we found similar MetS frequency in both groups, patients with knuckle pads should be examined for the presence of MetS components, especially abdominal obesity and hypertension.