Skin conditions

This chapter provides an overview of skin conditions affecting the hand, including nail pathology, benign and malignant skin tumours, and Dupuytren’s disease (DD). Although distortion of the nail occurs most commonly after trauma, nail changes may indicate other systemic causes (e.g. psoriasis), and may occasionally be due to underlying malignancy. Hands are exposed to sunlight and other occupational hazards (chemicals, radiation), and are vulnerable to skin cancer, most commonly squamous cell carcinoma. DD is often familial, commoner in men, and can affect the feet (plantar fibromatosis) and penis (Peyronie’s disease). Discreet areas of DD are now treatable by collagenase injection. Surgery is still indicated to restore function, either by fasciectomy (excision of DD) or dermofasciectomy (fasciectomy plus full thickness skin graft) where skin is involved or there is a secondary skin defect following fasciectomy. Patients should be counselled realistically about the post-operative recovery to full function, and that DD is not curable by surgery.