Introduction

Have you ever noticed a rash on your child’s skin that has been present for a long time and looks red and scaly? You’re probably wondering whether it could just be dry skin or something more serious. Skin infections are common in children, but how do you differentiate a fungal infection from a rash or an allergic reaction?

Tinea manuum is a type of ringworm that affects the hand. Since it resembles other common skin conditions, it is easily overlooked. This article explores the causes, diagnosis, treatment, and prevention of tinea manuum, as well as what to look for as a parent when examining your children’s skin if you suspect this condition.

This understanding enables you to make timely treatment decisions.

What is tinea?

Tinea, often referred to as Ringworm, is a superficial fungal skin infection commonly seen in Africa that can negatively impact the health and well-being of children.¹ Ringworm infections can also affect adults, although this is not as common. Importantly, tinea can also affect animals as well as humans.

In addition, although all ages and sexes can be affected, people assigned male at birth (AMAB) are affected more often than people assigned female at birth (AFAB). The rate of tinea infection among school-going children in Africa is approximately 10% - 30%.¹

Tinea is spread by direct physical contact between an affected and unaffected person, and transmits easily in overcrowded places like schools and refugee camps with poor hygiene, as well as through contamination of the surroundings and materials such as clothes and combs.^{1, 2}

It commonly affects the skin of the:^{2, 4}

• Scalp, causing ringworm of the scalp, also known as tinea capitis.
• Feet, causing athlete's foot, also known as tinea pedis.
• Groin, causing jock itch, also known as tinea cruris.
• Beard, causing ringworm of the beard, also known as tinea barbae.
• Body, causing ringworm of the body, also known as tinea corporis.
• Nails, causing ringworm of the nails, also known as tinea unguium.
• Hands, causing ringworm of the hand, also known as tinea manuum.

What is tinea manuum?

Tinea manuum is a superficial fungal infection of the palms of the hands, the back of the hand, or the folds in between the fingers of one or both hands. Reports suggest Dermatophytes, especially Hendersonula toruloidea and Scytalidium hyalinum, cause tinea manuum.³

Tinea Manuum is usually found coexisting with tinea pedis, known as “the two feet, one hand syndrome” (makes up 65% of cases).³

When tinea manuum only affects the hands, it is known as the localised form of the condition.. Like other dermatophytes, tinea manuum is not exclusive to just one part of the world, meaning it is distributed worldwide. Similar to the general tinea, tinea manuum is spread via skin-to-skin contact with an infected person, soil, objects, and animals.³

Causes

Tinea manuum is caused by dermatophytes, with Trichophyton rubrum being the most common dermatophyte causing the condition. However, other organisms have also been linked to tinea manuum; these include:³

• Trichophyton mentagrophytes 
• Epidermophyton floccosum
• Trichophyton verrucosum
• Trichophyton interdigitale
• Microsporum canis
• Microsporum gypseum
• Trichophyton eriotrephon
• Arhroderma benhamiae
• Trichophyton erinacei

Transmission of tinea manuum

Ringworm can be transmitted through:^{3, 5, 6}

• Direct, skin-to-skin contact with infected individuals
• Direct from one infected part of the body (e.g., feet or scalp).
• Direct contact with infected animals.
• Contact with objects, such as towels or clothing that belong to infected individuals.
• Contact with infected soil.

An individual who is infected can spread the infection 2 weeks before symptoms are observed, and it remains as long as the spores of the fungus are still present.

Associated risk factors for children

The risk factors associated with tinea manuum in children include:³

• Poor hygiene
• Previous skin infections/conditions like eczema, cuts, or abrasions.
• Exposure to infected soil and pets.
• Frequent sharing of items like towels, etc., with infected individuals.

Its appearance in children

Tinea manuum commonly affects one hand (unilateral) but can also affect both hands at the same time (bilateral). The most common presentation is “the two feet, one hand syndrome”.³ Early symptoms include mild redness on the hand, and the palms and fingers of the affected hand will appear dry and scaly.³ As the condition progresses, it becomes more severe. You may observe:³

• Raised edges surrounding a ring-shaped area on the hand.
• Thick skin that is cracked and peeling off.
• Itchy skin and irritation.
• When it is infected, you may see blistering or pus-filled swellings.

Other fungal infections in children that can be confused with tinea manuum include:³ 

• Eczema (bilateral, responds to steroids)
• Psoriasis (silvery plaques, no fungal elements)
• Contact dermatitis (associated with irritant exposure)

Diagnosis of tinea manuum in children

Diagnosis begins with the clinician taking a medical history, identifying any risk factors that may be present in the story described by the parents or the child. The area of concern is then observed, where the pattern of lesions is noted, as well as dryness and scaling of the skin.³

If the physician suspects a fungal infection, it can be identified by taking a small sample of the impacted skin and analysing it under a microscope (with a potassium hydroxide preparation) or by culturing the sample to confirm the exact fungal species causing the infection.³

Treatment of tinea manuum

Treatment of tinea manuum infection is based on the severity of the condition. Treatment may require:

• At-home care 
• Use of oral antifungal drugs (through the mouth) 
• Topical treatment (applied to the skin) 

Antibiotics may be needed if the tinea manuum is very severe.⁴

At-home care

When caring for a tinea manuum infection at home, it is vital to:

• Ensure the affected area is clean and dry.
• Avoid scratching the infected hand.
• Avoid sharing personal items like towels.

Antifungal medicines are used topically (i.e. on the skin) and orally.⁷

Preventing tinea manuum in children

We can avoid the spread of tinea manuum infection by:

• Encouraging good personal hygiene, e.g. regular hand washing.
• Avoid sharing clothes, towels, or bedding of an infected individual. 
• Proper washing and disinfection of shared materials with infected persons
• Early identification and treatment of infected pets.
• Educating caregivers on the infection and how to help reduce the spread, especially in schools.
• Educating children to stay away from pets infected with tinea manuum infection.

When to seek medical attention

If tinea manuum persists or worsens and spreads to the nails, or results in a fever or pus formation, it is necessary to see a doctor.

Summary

Tinea manuum in children is difficult to identify due to its resemblance to other skin infections. Knowing the specific signs, like red, itchy and scaly spots on the hand, will help with early care. It is a preventable and treatable condition and should never be ignored when noticed because early diagnosis and treatment will keep it under control. With good personal hygiene, early detection, and timely and effective antifungal treatment, it can be managed well.

It is also key to educate parents and anyone who looks after children regularly on how to prevent the spread amongst children. If you suspect tinea manuum in your child, reach out to a doctor immediately and get help.

FAQs

Q1. How can I tell if my kid has tinea manuum?

Answer - You might see a red, itchy and scaly spot on the hands. You can also look for ring-shaped spots with peeling skin, or thick spots on the skin of the hand.

Q2. Will tinea manuum infection go away itself?

Answer - No, you need a topical or oral antifungal treatment to treat it.

Q3. How long does it take to get better?

Answer - Mild infections will clear in 2-4 weeks with proper treatment. Severe infections may need up to 6 weeks of treatment.

Q4. Can my child still go to school if they have tinea manuum infection?

Answer - Yes, they can. However, it is crucial to teach them proper hand hygiene and not to share their items like toys or books to prevent spreading the infection to other children. It is also a good idea to inform the child’s school so that they can also enforce proper hygiene and further control infection transmission.

Q5. How can we stop reinfection?

Answer - To prevent recurring infections, we must ensure proper hand hygiene, avoid the sharing of towels and toys, and treat other fungal infections that will increase the risk of spread.

Q6. What happens if the infection does not get better with treatment?

Answer - If there is no improvement with treatment, see a doctor immediately for reassessment.