Tinea manuum: causes, symptoms, diagnosis, and treatment

Tinea manuum, also known as tinea manus, is a fungal infection on the palms and fingers.


Causes

The pathogens of tinea manuum are basically the same as those of tinea pedis, mainly trichophyton rubrum, followed by trichophyton mentagrophytes, which are often transmitted by scratches on the infected feet.


Signs and Symptoms

The initial skin lesions are vesicles on the fingertips, flexor side of fingers, and palms, with desquamation after drying. Skin lesions occur initially on 1 - 2 fingertips unilaterally, gradually spreading to the adjacent fingers or palms, and contralateral fingers may be infected afterwards. The skin at the desquamation can thicken, coarsen, and lose normal gloss and elasticity. Occasionally, interdigital erosions are also seen, which can also be caused by candida albicans.

According to different clinical presentations, tinea manuum can be divided into hyperkeratotic, ulcerative, and vesiculobullous tinea manuum.

Hyperkeratotic tinea manuum

Hyperkeratotic tinea manuum occurs mostly on the palms and is characterized by dry, thickened keratin, coarse surface with scales, deep skin lines, and chapped skin. The skin lesions can extend towards dorsal hands. Pruritus is generally absent, but pain may be present when the skin chaps.

Figure 1 hyperkeratotic tinea manuum

Vesiculobullous tinea manuum

Vesiculobullous tinea manuum is often solitary, initially on certain area of palms, especially the central palms, flexor side, lateral side, and root of the forefingers and ring fingers. The initial skin lesions are clustered or scattered, thick walled, shiny, pinhead sized vesicles containing clear fluids. The subjective symptoms are pruritus. Desquamation occurs after the vesicles dry, and skin lesions gradually extend peripherally, forming sharply demarcated, circular or polycyclic lesions. The illness develops slowly and persists for many years, until whole palms are involved and dorsal hands and nails are infected. Sometimes, vesicles may develop into pustules.

Figure 2 vesiculobullous tinea manuum

Ulcerative tinea manuum

Ulcerative tinea manuum occurs mostly in the interdigital spaces and is manifested by macerated, whitened, loose skin, flushing erosions, and even cracks. Different degrees of pruritus are present, and odors can be smelt when secondary infections occur.

Figure 3 ulcerative tinea manuum


Diagnosis

A diagnosis can be provided based on clinical findings. Potassium hydroxide (KOH) microscopic examination can assist in the diagnosis.


Treatment

Topical treatment

Hyperkeratotic tinea manuum can be treated with compound benzoic acid ointment, 3% clotrimazole cream, 1% econazole cream, 1% bifonazole cream, or 2% miconazole cream.

Vesiculobullous tinea manuum can be treated by hand baths with 0.2% lead acetate, followed by topical medications for hyperkeratotic tinea manuum.

Ulcerative tinea manuum can be treated with wet compress with 1% ethacridine solution and 1:5000 potassium permanganate solution, followed by topical medications for hyperkeratotic tinea manuum after drying.

Systemic treatment

Severe patients may require systemic treatment, and common systemic antifungals are terbinafine and itraconazol.