Tinea manuum

Tinea manuum is a fungal infection of the hand, mostly a type of dermatophytosis, often part of two feet-one hand syndrome.[2][4] There is diffuse scaling on the palms or back of usually one hand and the palmer creases appear more prominent.[2] 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]

Tinea manuum
Other namesTinea manus[1]
Tinea manuum hand
SpecialtyDermatology, infectious diseases
SymptomsDiffuse scaling, itch and prominent creases on palms[2]
ComplicationsSecondary bacterial infection[3]
CausesTrichophyton rubrum[2]
Risk factorsDiabetes, high blood pressure, weak immune system, humid surroundings, excessive sweating, recurrent hand trauma and cracks, pet owners, farmworkers.[3]
Diagnostic methodVisualization, direct microscopy, culture[3]
TreatmentTopical or oral antifungals[3]
MedicationTerbinafine, itraconazole, clotrimazole, fluconazole, ketoconazole[3]

The most common cause is Trichophyton rubrum.[2] The infection can result from touching another area of the body with a fungal infection such as athletes 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.[3] 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.[3] Psoriasis of the palms, pompholyx and contact dermatitis may appear similar.[3] 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.[3] One large study revealed around 84% of tinea manuum was associated with athletes foot, of which 80% admitted scratching their feet, and 60% were male,[6]

Signs and symptoms

There is usually an itch, with generalised dry flaky thick skin of the palm of a hand.[3] Frequently, one hand is affected, but it can be in both.[3] If the back of the hand is affected, it may appear as reddish circles like in ringworm.[3] Sometimes there are no symptoms.[3] The feet may be affected as in two feet-one hand syndrome.[2]

Cause and mechanism

The most common cause is Trichophyton rubrum.[2] 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.[3][5]

Tinea manuum can result from touching another area of the body with a fungal infection such as athletes foot or tinea cruris, contact with an infected person or animal, or from contact with soil or contaminated towels.[5]

Risk factors

Diabetes, high blood pressure, weak immune system, humid surroundings, excessive sweating, recurrent hand trauma and cracks in feet are risk factors for tinea manuum.[3] Pet owners and farmworkers are also at higher risk.[3][5]

Diagnosis

Diagnosis is by visualization, direct microscopy and culture.[3]

Differential diagnosis

Psoriasis of the palms, pompholyx and contact dermatitis may appear similar.[3]

Treatment

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.[3]

Prevention

Prevention is focussed on hygiene such as washing hands, avoiding scratching the feet or touching fungal toe infections.[3]

Epidemiology

Tinea manuum is most common in young adult males.[3] Dermatophyte infections occur in up to a quarter of the world's population, of which the hands and feet are most commonly involved.[3] It occurs worldwide.[3] One large study revealed around 84% of tinea manuum was associated with athletes foot, of which 80% admitted scratching their feet, and 60% were male, [6]

See also

References
  1. Grossman, Sheila (2014). "61. Disorders of skin integrity and function". Porth's Pathophysiology: Concepts of Altered Health States (9th ed.). Lippincott Williams & Wilkins. p. 1545. ISBN 978-1-4511-4600-4.
  2. Johnstone, Ronald B. (2017). "25. Mycoses and Algal infections". Weedon's Skin Pathology Essentials (2nd ed.). Elsevier. p. 441. ISBN 978-0-7020-6830-0.
  3. Chamorro, Monica J.; House, Steven A. (10 August 2020). "Tinea Manuum". StatPearls. StatPearls Publishing.
  4. Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 978-1-4160-2999-1.
  5. "Tinea manuum". dermnetnz.org. Retrieved 27 September 2021.
  6. McFadden, John; Puangpet, Pailin; Pongpairoj, Korbkarn; Thaiwat, Supitchaya; Lee, Shan Xian (2020). "8. Elimination or inclusion of non-allergic skin diseases". Common Contact Allergens: A Practical Guide to Detecting Contact Dermatitis. Hoboken: John Wiley & Sons. p. 104. ISBN 978-1-119-40571-9.
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