Dry and cracked hands in winter can be caused by environmental factors, such as cold and dry combined with unfavourable warmth and moisturisation of the hands. It may also be a symptom of a skin condition such as lichen planus or hereditary palmoplantar keratosis. Lichen planus can be characterised by diffuse roughness, thickening, flaking and dryness of the skin on the hands, usually without significant itching, and is prone to cracking and even pain and bleeding in the dry winter months; hereditary palmoplantar keratosis often develops in infancy and can be associated with itching, tenderness and cracking, which worsens in winter.