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Atypical mycobacterial infection

Often acquired from contaminated water ("fishtank granuloma"), this infection typically presents as a localized, crusted nodule or plaque on the hand that can spread up the arm.

Basal cell carcinoma

Rare on the hands, but can present as a pearly papule with telangiectasias that may ulcerate.

Calcinosis cutis

Deposits of calcium in the skin, which can present as hard, white, subcutaneous nodules on the fingertips, especially in systemic sclerosis.

Cowpox

A viral infection from rodents or cats, causing a painful, hemorrhagic or necrotic lesion on the hand or arm.

Deep fungal infection

Infections like sporotrichosis can start as a fixed, ulcerative, or verrucous nodule on the hand at a site of trauma.

Ganglion

A firm, smooth, non-tender cystic structure attached to a tendon sheath or joint, most commonly on the back of the wrist.

Gouty tophi

Deposits of uric acid crystals forming firm, white-to-yellowish subcutaneous nodules over the joints of the hands.

Milker's nodule

A viral infection from cattle, causing one or more firm, reddish-blue, painless nodules on the hands, often with a central depression.

Multicentric reticulohistiocytosis

A rare systemic disease causing destructive arthritis and characteristic reddish-brown "coral bead" papules around the nail folds.

Myiasis

Infestation of the skin by fly larvae, which can present as a furuncle-like nodule with a central punctum from which the larva breathes.

Orf

A viral infection from sheep or goats, presenting as a solitary, firm, reddish papule on the hand that evolves into a large, weeping nodule with a violaceous rim and central umbilication.

Palmar xanthomata

Yellowish, flat or slightly elevated plaques within the palmar creases, which are pathognomonic for type III hyperlipoproteinemia.

Pyogenic granuloma

A benign, rapidly growing vascular proliferation that presents as a bright red, friable, raspberry-like nodule that bleeds very easily, common on the hands.

Rheumatoid nodule

A firm, non-tender, subcutaneous nodule found over joints and pressure points, such as the knuckles, in patients with rheumatoid arthritis.

Squamous cell carcinoma

A common skin cancer on the sun-exposed dorsal hand, presenting as a crusted, scaly, indurated, and often ulcerated nodule.

Tendon xanthoma

Firm, stony-hard, subcutaneous nodules that are attached to tendons, especially the extensor tendons of the hands, seen in familial hypercholesterolemia.

Viral wart

A common, hyperkeratotic, papillomatous growth (verruca vulgaris), often on the hands, which can have thrombosed capillaries appearing as black dots.

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