Finger pebbles are clinically described as fine papillary structures over the dorsum of the interphalangeal and metacarpophalangeal joints. Although no definite cause for these lesions has been identified, they are usually associated with diabetes mellitus. In this article we describe a case of finger pebbling with more pronounced and confluent pebbling than previously described. In the patient described below, the diagnosis of diabetes mellitus was based on this cutaneous sign of systemic disease. This article further discusses the original studies examining finger pebbles and provides treatment suggestions.