Stubborn hand rash

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Stubborn hand rash

J Fam Pract. 2012 July;61(7):421-424

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References

1. Habif TP. Clinical Dermatology: A Color Guide to Diagnosis and Therapy. 5th ed. Philadelphia, Pa: Mosby/Elsevier; 2010:491–540.

2. Wilson M, Bender S, Lynfield Y, et al. Two feet-one hand syndrome. J Am Podiatr Med Assoc. 1988;78:250-253.

3. Daniel CR 3rd, Gupta AK, Daniel MP, et al. Two feet-one hand syndrome: a retrospective multicenter survey. Int J Dermatol. 1997;36:658-660.

4. Park BC, Lee SJ, Kim do W, et al. Molecular identification of mycologic correlation in patients with concomitant tinea pedis and tinea manuum infection. Arch Dermatol. 2009;145:205-207.

5. Zhan P, Ge YP, Lu XL, et al. A case-control analysis and laboratory study of the two feet-one hand syndrome in two dermatology hospitals in China. Clin Exp Dermatol. 2010;35:468-472.

6. Drake LA, Dinehart SM, Farmer ER, et al. Guidelines of care for superficial mycotic infections of the skin: tinea capitis and tinea barbae. J Am Acad Dermatol. 1996;34(2 pt 1):290-294.

7. Geary RJ, Lucky AW. Tinea pedis in children presenting as unilateral inflammatory lesions of the sole. Pediatr Dermatol. 1999;16:255-258.

8. Sweeney SM, Wiss K, Mallory SB. Inflammatory tinea pedis/manuum masquerading as bacterial cellulitis. Arch Pediatr Adolesc Med. 2002;156:1149-1152.

9. Gupta AK, Cooper EA. Update in antifungal therapy of dermatophytosis. Mycopathologia. 2008;166:353-367.

10. Gupta AK, De Doncker P, Degreef H. Tinea manus treated with 1-week itraconazole vs. terbinafine. Int J Dermatol. 2000;39:529-531.

Diagnosis: Tinea manuum

This patient was given a diagnosis of tinea manuum, also known as two feet-one hand syndrome, a dermatophyte infection. The patient was initially treating his rash appropriately with the topical antifungal, but failed to treat his concomitant tinea pedis.

The infection is believed to be spread from the feet to the hand by scratching, as tinea pedis or onychomycosis of the toenails precede infection of the hand.¹ Whether one is right-handed or left-handed does not appear to play a role in which hand is affected.^2,3 However, the hand used to scratch or pick the feet is usually the hand that becomes involved.^3,4 The condition is more common in men and it tends to develop at an earlier age in patients who work with their hands.³

Tinea manuum is rare, with occurrence rates ranging from 0.3% to 0.7% of those with superficial fungal infections.⁵ The true culprit in two feet-one hand syndrome are the feet. Unlike tinea manuum, tinea pedis is the most common fungal skin infection in North America and Europe.⁶ The most common agents isolated in tinea pedis are Trichophyton rubrum, Trichophyton mentagrophytes, and Epidermophyton floccosum.⁷

The condition presents in one of 4 ways

The differential for two feet-one hand syndrome includes contact dermatitis, an Id reaction (autoeczematization), cellulitis, or a herpetic lesion.^2,8

FAST TRACK

Making the diagnosis is straightforward with a good history and physical—and a potassium hydroxide test.

Tinea pedis generally presents in one of 4 ways:¹

Classic ringworm features an erythematous, scaly, well-circumscribed rash on the feet.
Interdigital tinea pedis has toe web involvement, often between the fourth and fifth toes. It can transition between dry and scaly to soft, soggy, and macerated. Skin may become white and fissures may arise. Pruritus is often worse after the toes dry.
Moccasin type (plantar hyperkeratotic tinea pedis) features a fine white silvery scale that often covers the entire sole. Skin may be pink and itch. The dorsum of the feet is not usually involved.
Acute vesicular tinea pedis is a highly inflammatory infection with vesicles that may coalesce into bullae. It likely stems from a chronic infection and is more common when occlusive shoes are worn.

Stubborn hand rash

References

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