Introduction

Tinea Manuum (TM) is a fungal infection that results in inflammation of the hands, which can lead to a rash on the palms or in between the finger digits that may look red and inflamed.¹ It can be sudden onset (acute) or occur over a long period (chronic).

 A common name for Tinea Manuum is ‘ringworm.’ It can be spread by coming into contact with infected sites, materials, animals or soil. There is treatment for TM, however, to properly treat the infection, it needs to be accurately diagnosed. 

Overview of Acute vs. Chronic Forms 

Acute Tinea Manuum (ATM) has distinct raised edges with a centre, is more red and inflamed and itchy. Chronic Tinea Manuum (CTM) presents in a more scaly, dry patch that is thicker, less inflamed and less red. It develops over a longer period of time and can cause discomfort.

Causes 

Microorganisms found in the environment such as the soil and on animals that frequently share spaces with humans, as well as those present in infected individuals, can spread the fungal infection. Microorganisms that live on the skin are known as dermatophytes. These include:

Zoophilic and geophilic dermatophytes:

• Trichophyton erinacei: hedgehog²
• T. verrucosum: cattle
• Microsporum canis: cat or dog
• Nannizzia gypsea: soil.

Fungi that infect humans (Anthropophilic dermatophytes):

• T. rubrum
• T. interdigitale
• Epidermophyton floccosum.

 Modes of Transmission 

• Direct contact with another infected site like the feet 
• Direct contact with an infected animal or soil 
• Direct contact with objects that may be carrying the pathogen ie. garden tools

Risk Factors 

Infection from fungi causing Tinea Manuum can also be impacted by geographical locations and climate as fungi vary, therefore so will the prevalence of infection. Understanding that there are multiple factors that contribute to infection is important in providing adequate support, health care advice and preventative actions. These include other factors such as:

• Occupational risk: Those who undergo heavy physical labour and sweat a lot¹ 
• Environmental stress: work in wet conditions that are conducive to the fungal infection or in contact with chemicals that disrupt the skin barrier 
• Underlying conditions: dermatitis, immunosuppression, immune dysfunctions or dysregulation^1,3

Clinical Presentation

 Acute Tinea Manuum

• Symptoms present quickly
• Inflamed, raised edges with a clear centre (ringworm)
• Itchy and may also have a burning sensation and can also only present on one hand instead of both
• Blistering rash (vesicles on the skin) when it bursts it can be sticky. This type of infection is associated with itching and burning.
• It can present on one hand and then also be present on both feet (commonly referred to as one-hand, two-foot syndrome)¹

Chronic Tinea Manuum

• Presents slowly but more persistently 
• The affected area can scale, be dry and form harder skin (also known as Hyperkeratotic Plaques)⁴ 
• Unlike ATM CTM can affect both hands

Diagnostic Methods

Diagnosis includes taking a scraping off the affected area and performing tests such as those associated with mycology to determine the causative pathogen ie. fungi

Treatment Strategies

Acute Tinea Manuum Treatment

• Topical antifungals may be prescribed (such as Azoles and Allylamines)
• In more severe cases oral antifungal (including Terbinafine and Itraconazole)
• Alternative approaches for symptom relief include moisturizers and anti-inflammatories

Chronic Tinea Manuum Treatment 

• Chronic prescription of oral antifungals
• A combination of both oral and topical treatments for extended periods
• Addressing causative factors and managing the exposure to frequently infected sites. This may involve treating other infected sites such as athlete's foot

Prevention and Recurrence Management

• Improved hygiene practices like frequent washing and drying of hands 
• Avoid contaminated objects or use gloves to prevent direct contact with infected objects ie. When  treating infected feet wear disposable gloves
• Treat other infected areas
• Conduct regular follow-up appointments  in those individuals at risk of recurring infections or dermatitis 

Conclusion

• ATM and CTM can be painful and uncomfortable skin infections associated with exposure to contaminated surfaces or influenced by lifestyle, or sensitive skin. Understanding the difference between acute presentation and chronic presentation can help in prevention, faster treatment and management of symptoms
• ATM is red, inflamed and often looks like ringworm. CTM presents are less red and inflamed but more scaly and lesions can have harder thickened skin 
• Topical antifungal treatments can be used in both cases as well as moisturizers and anti-inflammatories to manage symptoms. In chronic conditions, oral antifungals are often prescribed

FAQs

What is ringworm?

Ringworm is not caused by a worm but rather a fungal infection caused by dermatophytes. It presents as a circular inflamed ring, with raised edges and a clear center. Treatments include topical antifungals and specific moisturisers to alleviate the dryness.

Is ringworm contagious?

Answer: Yes, ‘ringworm’ which is a fungal infection is contagious and can spread from one infected site to another if it is not treated and managed properly.