I actually think your shading on the hand is believable. An emaciated beggar would have noticeable, very prominent bony structure under skin stretched thin with age and lack of food, not to mention the fact that skin tends to turn slightly transparent with age. It does look skeletal, but it fits with what one might expect to see anatomically.
Your style is pretty effective but here I think it would work better to smooth out the back of the hand rather than picking out each knuckle and tendon. They really would not be that noticeable in reality, and it looks odd.
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