Small wounds to the backs of the hands can be caused by punching or being hit. Wounds on the backs of the forearm could be defense injuries. The inside of the non-dominant forearm is the usual location of self-inflicted wounds. Superficial abrasions or reddening around the wrists could have been caused by tight handcuffs or cords. At a later stage there is often hair loss and there may be hyperpigmentation.
Finger and toe nails can be extracted or crushed during torture, but the late appearance is normally indistinguishable from infection or innocent trauma. Vaccination scars should be noted to ensure they are not attributed to ill-treatment. if the nail has been pulled off, an overgrowth of tissue may occur from the proximal nail fold.
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