Systemic Diseases
DESCRIPTION
The hands, being composed of many types of tissue, including blood vessels, nerves, skin and skin-related tissues, bones, and muscles/tendons/ligaments, may show changes that reflect a disease that affects other parts of, or even the whole body (systemic diseases). The hands may show changes noticed by the patient or his/her hand surgeon even before the systemic disease is detected.
CAUSES
SIGNS AND SYMPTOMS
Arthritic Swelling (Figure 1)  
Arthritic swelling of the middle joint of a finger is called a Bouchard's node.  The swellings at the small finger joints are called Heberden's nodes. 

Dactylitis (Figure 2) 
This case of dactylitis was associated with psoriatic arthritis.  In this photo, the swelling extends from the palm to include the ring finger out to the small joint.  Stiffness is common. There also may be pain.  This swelling may be improved with medicines for the problem causing it. 

Mucous Cyst (Figure 3)  
This type of cyst is called a mucous cyst.  If the skin becomes thin, the cyst may break resulting in drainage of a clear sticky fluid.  The resulting break in the skin may allow bacteria to reach the nearby joint, causing a joint or bone infection. 

Red Dots (Figure 4)  
The small red dots seen above are in the thin part of the skin around the nail. They may also occur in the thicker pink part. This has been seen in dermatomyositis, systemic lupus, and scleroderma. 

Leukonychia (Figure 5)
Leukonychia can be seen with viral infections, intestinal and kidney diseases, poisoning, and medicines. The nail may come loose from the nail bed because of fungal infections or other causes. 

Red Streaks (Figure 6) 
Red streaks seen in the fingernail area can be due to hemorrhage (bleeding).  These are called splinter hemorrhages and have been seen in endocarditis (heart infection), although also reported in psoriasis, and trichinosis. 

Psoriasis (Figure 7) 
Psoriasis commonly affects the nail and nailbed.  Pits in the nail, loosening, blood streaks beneath the nail, and other changes may occur.  A psoriasis skin patch is seen in the middle. 

“Pincer” Nail (Figure 8)
This “Pincer” nail with an abnormal side-to-side shape curve can be seen at birth or simply due to aging.  However, it can also be caused by changes in the bone beneath because of disease (gout in this case).
TREATMENT
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Copyright 2014 by American Society for Surgery of the Hand