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Hand dermatitis is a common skin disorder that can negatively impact a patient's daily life and occupation. The necessity and frequency of hand use can expose the overlying skin to irritation, trauma, and observation from others. This can make hand dermatitis irritating to active hands and difficult to treat, as irritant exposure is often difficult to avoid. Due to the variable degrees of presentations of hand dermatitis, it is essential for dermatologists to adequately recognize the variable presentation, establish a definitive diagnosis, and develop an appropriate treatment. This review explores the pathogenesis, clinical types, diagnosis methods, treatment, and prognosis of hand dermatitis. ( SKINmed . 2019;17:30-34).

A 59-year-old Native American female presented with a 4-day history of malaise, abdominal pain, nausea, jaundice, and a "sunburn-like rash" on the upper chest and back despite lack of recent sun exposure (Figure 1). Medical history was significant for a twenty-year history of universal vitiligo and a five-year history of rheumatoid arthritis (RA) treated with methotrexate (MTX), adalimumab, prednisone, and naproxen sodium. Cutaneous examination revealed hemorrhagic crusting of upper and lower lips (Figure 2), scleral icterus, diffuse jaundice of the skin, and well-demarcated erythematous patches on mid-upper back and anterior neck. The patient had a few scattered erythematous papules with whitish center on bilateral extensor surfaces of the upper extremities and scattered petechiae on both the trunk and upper extremities.

Many diseases can result in nail thickening, such as psoriasis, onychomycosis, pityriasis rubra pilaris, pachyonychia, and ichthyosis. In this report, the authors discuss such a condition, called onychogryphosis. Onychogryphosis is a thickening of the nail plate, with associated gross hyperkeratosis and increased curvature. It can be oyster-like or resemble a ram's horn. Its irregular surface is marked by longitudinal and transverse striations, the latter of which is more frequent. The diagnosis of onychogryphosis is difficult to identify in the early stages because hypertrophy of the nail plate is the earliest manifestation, with the more classical features appearing later. Onychogryphosis is common on the great toenail of elderly patients and can be associated with self-neglect, homelessness, dementia, old age, trauma, peripheral circulation disorders, diseases of the central nervous system, and foot abnormalities, such as hallux valgus, elephantiasis, long-standing poor personal care, hyperuricemia, and pressure from improper footwear. All fingers and toenails can be affected in hereditary onychogryphosis. In infants and children, the presence of onychogryphosis can be accompanied by congenital malalignment of the great toenail.