Do a skin scraping
Diagnosis can be easily made with a good history and physical and a potassium hydroxide test. If a scraping from the hand proves to be fungal, a thorough inspection of the feet should be undertaken, as tinea manuum alone is uncommon.
Tx is the same for feet and hand
Topical antifungals such as terbinafine, clotrimazole, or ketoconazole are first-line therapy for the feet and hand.9 Consider oral antifungals if the affected area is large, the patient doesn’t respond to topical therapy, or the patient is immunocompromised.9,10
When oral therapy is initiated for tinea manuum, one week of itraconazole (200 mg twice daily for 7 days) has been shown to be as effective as 2 weeks of oral terbinafine (250 mg daily for 14 days).10
Oral therapy worked for my patient
In light of the patient’s previous failure with topical therapy, he was reluctant to try this approach again. After a normal hepatic panel, I started him on a 2-week course of oral terbinafine 250 mg daily. (Terbinafine was available at our clinic pharmacy, while itraconazole was not). Follow-up at one month showed no sign of previous infection.
CORRESPONDENCE LT Michael Crandall, MD, Department of Dermatology, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134; mikecrandall7@gmail.com