| Tinea manuum | |
| Field: | Dermatology, infectious diseases |
| Synonyms: | Tinea manus[1] |
| Symptoms: | Diffuse scaling, itch and prominent creases on palms |
| Complications: | Secondary bacterial infection[2] |
| Causes: | Trichophyton rubrum |
| Risks: | Diabetes, high blood pressure, weak immune system, humid surroundings, excessive sweating, recurrent hand trauma and cracks, pet owners, farmworkers. |
| Diagnosis: | Visualization, direct microscopy, culture |
| Treatment: | Topical or oral antifungals |
| Medication: | Terbinafine, itraconazole, clotrimazole, fluconazole, ketoconazole |
Tinea manuum is a fungal infection of the hand, mostly a type of dermatophytosis, often part of two feet-one hand syndrome.[3] [4] There is diffuse scaling on the palms or back of usually one hand and the palmer creases appear more prominent.[3] When both hands are affected, the rash looks different on each hand, with palmer creases appearing whitish if the infection has been present for a long time.[5] It can be itchy and look slightly raised.[5] Nails may also be affected.[5]
The most common cause is Trichophyton rubrum.[3] The infection can result from touching another area of the body with a fungal infection such as athlete's foot or fungal infection of groin, contact with an infected person or animal, or from contact with soil or contaminated towels.[5] Risk factors include diabetes, high blood pressure, weak immune system, humid surroundings, excessive sweating, recurrent hand trauma and cracks in feet.[2] Pet owners and farmworkers are also at higher risk.[5] Machine operators, mechanics, gas/electricity workers and people who work with chemicals have also been reported to be at greater risk.[6]
Diagnosis is by visualization, direct microscopy and culture.[2] Psoriasis of the palms, pompholyx and contact dermatitis may appear similar.[2] Treatment is usually with long-term topical antifungal medications.[5] If not resolving, terbinafine or itraconazole taken by mouth might be options.[5]
It occurs worldwide.[2] One large study revealed around 84% of tinea manuum was associated with athlete's foot, of which 80% admitted scratching their feet, and 60% were male,[6]
There is usually an itch, with generalised dry flaky thick skin of the palm of a hand.[2] Frequently, one hand is affected, but it can be in both.[2] If the back of the hand is affected, it may appear as reddish circles like in ringworm.[2] Sometimes there are no symptoms.[2] The feet may be affected as in two feet-one hand syndrome.[3]
The most common cause is Trichophyton rubrum.[3] Other causes include Trichophyton verrucosum (from cattle), Microsporum canis (from a cat or dog), Trichophyton erinacei (from a hedgehog), Trichophyton mentagrophytes, Epidermophyton floccosum, Trichophyton interdigitale, and more rarely Microsporum gypseum, Trichophyton eriotrephon, and Arhroderma benhamiae.[2] [5]
Tinea manuum can result from touching another area of the body with a fungal infection such as athlete's foot or tinea cruris, contact with an infected person or animal, or from contact with soil or contaminated towels.[5]
Diabetes, high blood pressure, weak immune system, humid surroundings, excessive sweating, recurrent hand trauma and cracks in feet are risk factors for tinea manuum.[2] Pet owners and farmworkers are also at higher risk.[2] [5]
Diagnosis is by visualization, direct microscopy and culture.[2]
Psoriasis of the palms, pompholyx and contact dermatitis may appear similar.[2]
Prevention is focussed on hygiene such as washing hands, avoiding scratching the feet or touching fungal toe infections.[2]
Treatment is usually with long-term topical antifungal medications.[5] If not resolving, terbinafine or itraconazole by mouth might be options.[5] Other options include clotrimazole, fluconazole and ketoconazole.[2]
Tinea manuum is most common in young adult males.[2] Dermatophyte infections occur in up to a quarter of the world's population, of which the hands and feet are most commonly involved.[2] It occurs worldwide.[2] One large study revealed around 84% of tinea manuum was associated with athlete's foot, of which 80% admitted scratching their feet, and 60% were male, [6]