Complaints & connections · borters.ch
Tinea manuum
Almost always one hand, and almost always both feet involved too — treating the hand alone brings the fungus back from the foot.
Also known as: tinea manus · two feet–one hand syndrome · hand mycosis · dermatophyte of the hand
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
A dermatophyte colonises the outer horny layer of the hand. The picture is unremarkable, and that is exactly why it is taken for dry skin for so long: a dull, dry surface with fine floury scaling that collects in the palm creases and looks as if flour had been dusted into them. It need not itch. On the back of the hand the familiar ring shows, with a more scaly rim and paler middle; in the palm it is more a dry, scaling surface without a clear ring.
The one-sidedness is the marker. In most cases only one hand is involved — and very often both feet are affected at the same time. This pattern has its own name: two feet, one hand. The route usually runs from foot to hand, by way of creaming, scratching, socks. That also explains why treatment aimed at the hand alone starts again the following year.
From the skin the fungus can travel into the nail. It begins at the free edge or the side: the nail turns whitish to yellowish, thickens, crumbly material collects under the plate, and the plate lifts from the nail bed. It is the same fungus, but a different timescale. The skin is settled in weeks; the nail takes months because it has to grow out — a fingernail grows about three millimetres a month and is replaced in four to six months, a toenail needs a year and more.
It is settled by a scale sample: scrape, microscope, plus culture or PCR. Two things decide between success and a detour. First the order — scrape before creaming. An antifungal cream used beforehand makes the test falsely negative for two to four weeks. Second the steroid: on a fungus it takes away redness and itch for a few days while the fungus spreads on under the quietened surface. That picture has a name, tinea incognita, and it is the commonest reason a small patch ends up as the whole hand.
The scale sample takes minutes and decides between two opposite treatments. It belongs before the first cream: an antifungal makes microscope and culture falsely negative for two to four weeks.
In the two feet–one hand pattern the foot is the source. Creaming only the hand treats the result and leaves the origin. Shoes and socks belong to it: wash socks hot, let shoes dry.
The cream goes two to three centimetres beyond the visible border — the fungus is already there and only becomes visible later. And it is carried on for one to two weeks after healing. Stopping too early is the commonest reason for relapse.
While only the skin is involved, treating on the surface is enough, usually two to four weeks. If the nail is involved, lacquer is only enough for limited edge involvement; otherwise treatment is taken by mouth, and a liver value belongs beforehand. The reckoning is in months, not weeks.
The fungus needs moisture and contact. Really dry hands and feet after washing, especially between fingers and toes, own towels, no bare feet on shared wet floors. That is not a rule of cleanliness but the breaking of a route.
An unrecognised high blood sugar makes skin and nail fungus more frequent and more stubborn. One HbA1c costs little and sometimes explains the return that every cream only briefly settles.
The most useful distinguishing feature. Hand eczema and psoriasis usually sit on both sides; hand fungus stays on one hand for a long time. If both hands are equally involved, think of something else first.
The fine whitish scaling collects in the furrows of the palm and traces them. Simple dry skin does not draw that line so sharply.
Look at the toe clefts, the soles, the toenails. Something there is the best clue available without a laboratory — and the reason the treatment must aim at both places.
From the free edge or the side: whitish-yellow, thickened, crumbly underneath, the plate lifts. A single nail on the affected hand fits the picture; all nails at once argues against it.
The course that gives it away. The ointment takes redness and itch for days; afterwards the area is larger than before and the border blurred. That is not a failure of the ointment but the pointer to the fungus beneath.
Unlike eczema, the itch is often missing entirely. Because nothing presses, months to years often pass before it is looked at — and in that time the fungus moves into the nails.
Worth doing with recurring or extensive fungal findings. A persistently raised sugar explains frequency and stubbornness; a normal value rules that route out.
Not for the diagnosis but for the tablets: before an antifungal taken by mouth over weeks to months the liver value is measured, and again during longer treatment.
Not a hormone that makes the fungus — but a high blood sugar supplies the skin with more sugar and weakens the defence at the surface. Hence recurring fungus and sugar metabolism belong in the same view.
No diet drives out a dermatophyte, and none feeds it. The only solid link runs through a persistently high blood sugar, which makes fungal findings more frequent and more stubborn.
Studied on the foot, not the hand: 25 to 50 per cent over four weeks improved the picture, laboratory clearance reached the level of standard creams distinctly less often. It can itself set off a contact eczema, and on the nail it barely gets through the plate.
Undiluted it irritates. For use on skin it is diluted in a carrier oil; the concentrations studied on the foot were distinctly higher than those usual in aroma care.