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Tinea manus in Adult
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Tinea manus in Adult

Contributors: Jill K. Wieser MD, Susan Burgin MD
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Synopsis

Tinea manus (known in the plural form as tinea manuum) is a superficial dermatophyte infection involving one or both hands. In most cases, a single hand is involved; when both hands are affected, the involvement is generally asymmetric. Tinea manus may be associated with two feet-one hand syndrome, in which the locations of infectious involvement correspond with its name. Tinea infections are more common postpuberty, and men are more often affected than women. Lower socioeconomic status is also a risk factor. There does not appear to be a difference in prevalence between ethnicities.

The etiology is frequently related to autoinoculation (ie, contact with a separate site of infection such as the foot or groin) or contact with an infected individual, animal, soil, or object (eg, an infected towel). Due to the frequency of autoinoculation, causative organisms are often similar to those involved in tinea pedis and tinea cruris: Trichophyton rubrum, Trichophyton mentagrophytes, and Epidermophyton floccosum. Two nondermatophyte fungi that can lead to a similar clinical picture are Scytalidium dimidiatum and Scytalidium hyalinum.

Signs and symptoms can include scaling of involved skin and pruritus; painful fissuring and maceration can occur, especially if there is interdigital involvement. Morphology often differs based on location. Infection of the palm often appears as a thin, white, scaly accentuation of the palmar creases with fine, powdery surrounding scale, whereas dorsal hand involvement appears similar to tinea infections elsewhere on the body, as an annular or serpiginous scaly plaque with leading edge and central clearing. This difference in appearance is thought to be related to the lack of sebaceous glands on the palms. Clinical variants include interdigital, hyperkeratotic (most frequently seen on the palmar surfaces), exfoliative, papular, and vesiculobullous forms.

Rarely, a dermatophytid reaction (autoeczematization, or id reaction) may occur in association with tinea manuum; this is a form of hypersensitivity that can be seen in relation to a distal superficial dermatophyte infection. It generally appears as a symmetric, generalized pruritic eruption and can be associated with constitutional symptoms.

Immunocompromised Patient Considerations
Generally, tinea infections may be more severe and chronic / recurrent in immunosuppressed patients, such as those with human immunodeficiency virus (HIV) disease or common variable immunodeficiency syndrome.

Related topic: Tinea corporis

Codes

ICD10CM:
B35.2 – Tinea manuum

SNOMEDCT:
48971001 – Tinea manus

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Hand dermatitis (including contact, irritant, atopic, dyshidrotic) – Patient history can aid in differentiation with or without patch testing for contact hand dermatitis.
  • Palmoplantar psoriasis – Generally not pruritic; look for additional signs of psoriasis such as nail changes (pitting, oil spots, onycholysis) and well-demarcated erythematous plaques with a silvery scale elsewhere on the body. Assess for family history of psoriasis.
  • Keratolysis exfoliativa – Usually not pruritic; begins with superficial vesicles on the palms that leave a collarette of scale upon rupturing.
  • Erythrasma – Can appear similar to interdigital tinea infection; use a Wood's lamp to detect the characteristic coral red fluorescence seen with Corynebacteria.
  • Secondary syphilis – Consider treponemal assay or rapid plasma reagin (RPR) test if given the appropriate clinical history or a high-prevalence setting.

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed:10/10/2019
Last Updated:11/12/2019
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