Tinea manus in Child
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
B35.2 – Tinea manuum
48971001 – Tinea manus
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.
- Juvenile plantar dermatosis – Usually seen in children aged 3-14. Feet are equally affected and appear shiny, dry, and red; palms and fingertips are rarely affected.
- 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 – In sexually active teenagers, consider treponemal assay or rapid plasma reagin (RPR) test if given the appropriate clinical history or a high-prevalence setting.