Disease name and synonyms

Tinea manuum refers to superficial fungal infection of one of both hands

Fungi responsible (links to these)

Trichophyton interdigitale, Epidermophyton floccosum and Trichophyton rubrum. Occasionally other fungi.

Disease description

Usually unilateral, especially on the right. Always asymmetrical. Two distinct forms. The dyshidrotic (eczematoid) form presents with raised scaly or vesicular lesions and marked itching and burning. The hyperkeratotic form gradually gets worse with a gradually enlarging dry area of involvement leading to extensive involvement of most of the palm and fingers. Fissures and thickening of the skin making the hands rough is common.

Frequency and global burden

Worldwide, frequency unknown but uncommon among skin fungal infections.

Underlying problems and at risk patients

None, usually acquired from other infected individuals.

Diagnostic testing

Skin scraping for culture and microscopy.

Treatments

Topical azole therapy (ie econazole or clotrimazole) is usually successful, if applied for at least 10 days and possibly longer if extensive disease. Oral itraconazole (200mg/d) or terbinafine (250mg/d) are also highly effective, if given for 2-4 weeks.

Outlook and prognosis

Excellent outlook. Fingernail involvement should also be sought and treated.