Introduction

Tinea manuum (ringworm) is a skin disease that appears on the hands and fingers. It comes from fungi, specifically Dermatophytes, which grow in parts rich in keratin.¹ Dermatophytes are fungi that mainly grow in keratin-rich areas of the body. The most common dermatophyte that causes Tinea manuum is Trichophyton rubrum. Have you ever thought where its name came form?  It shows up as rings on the skin with a clear spot in the middle. Tinea manuum usually occurs only on one hand but can spread to other body parts like in two foot, one-hand syndrome: This problem occurs when the fungus hits one hand and both feet.

 Fungal infections related to ringworm affect 10-25% of people worldwide, which makes Tinea manuum a rare infection.¹

Causes and transmission

You can catch the Tinea   Manuum by touching people or animals who have it. It can also spread from dirty surfaces,   this is common in sports areas like gyms, locker rooms, and on mats.²

Importance of prevention

Tinea manuum should be prevented because it spreads easily and quickly via physical contact or sharing items. The infection can reappear after treatment and can spread to close family members and friends. Therefore, management steps should be taken to reduce the occurrence and spreading of the infection.

Risk factors

Risk factors are traits that have an increased likelihood of being infected by Dermatophytes. One of the risk factors includes occupational hazards, where some workers are more likely to get infected due to a higher risk of exposure. For example, farmers can sometimes get infected by soil that contains Dermatophytes. Another category of people who are prone to this fungal infections are people who have Hypertension or Diabetes mellitus. Additionally, people who are assigned male at birth are more likely to deal with fungal infections than people who are assigned female at birth. men are more likely to deal with fungal infections than women. 

Another cause of Tinea manuum is people have inherited ringworm.³ People who have inherited tinea manuum are prone to fungal infections and have to manage recurring infections throughout their lives. Sometimes, other fungal infections, such as athlete’s foot can also make you prone to tinea manuum.

Risk factors can vary depending on the geography, for example, studies in India showed that improper hygiene practices and prolonged topical steroid usage resulted in increased ringworm infections. Improper hygiene practices could mean not washing hands properly, not bathing regularly or sharing towels or clothes.⁴

Steps to prevent tinea manuum from spreading

Multiple steps can be taken to prevent tinea manuum from spreading.  Personal hygiene practices; it includes washing your hands regularly with soap and water, especially after being exposed to high-risk areas such as gyms, gardens and areas with animals.^1,2 It is also best practice to wear protective gloves to reduce exposure to the infection. It is not recommended to share towels, combs or bedsheets with someone who is diagnosed with tinea manuum. 

There are other steps such as ensuring a clean environment. Disinfect commonly touched surfaces especially in sports settings, such as cleaning sports mats after use, encouraging people who use gym facilities and athletes to shower soon after they interact with each other to reduce the chances of transmission and pretreating surfaces with barrier foam before interacting.⁵ This is because the fungi that cause tinea manuum can survive on surfaces. People who frequent gyms and other sports facilities are also encouraged to wear footwear to prevent infections from spreading to the feet and subsequently their hands (tinea manuum).⁶

Regular care and maintenance can help prevent spreading such as keeping your skin dry and well-moisturised without creating excess humidity since fungi tend to grow best in humidity. In order to prevent an infection, you can use antifungal powders in moisture-prone areas to lock in the moisture thereby preventing growth of Dermatophytes.⁷ If you suspect you have tinea manuum, warn the people you are living with to wash anything you all have shared such as clothes, bedsheets, combs and towels. You should try your best not to scratch the rash because the fungal infection can spread to other parts of the body. 

You should also take your pets to the veterinarian immediately if you see signs of ringworm as this could spread to your hands causing you to catch tinea manuum yourself too. Pets with ringworm usually have a ring-shaped rash on their skinsindicating a fungal infection.

What do you do when you suspect you have tinea manuum?

Recognising symptoms

Symptoms of tinea manuum include scaly and itchy rashes. On lighter skin, the rashes may appear reddish or pink, and on darker skin, you may see grey or brown rashes. You might not see a raised ring-shaped patch as seen in most ringworm infections. As shown in Figure 1 above, you may see white-coloured scaling along the lines of your palms and fingers.⁸ There can be blistering or peeling around your fingers and it can spread to the fingernails if left untreated.⁹

Seeking medical advice

It is best to consider a topical anti-fungal treatment such as terbinafine as this is applied directly to the rash.¹⁰ The NHS recommends starting treatment promptly by consulting a pharmacist and getting an over-the-counter medication. You should also wash your towels and bedsheets as much as possible. It is also advised not to scratch or touch the rash to prevent further spreading. Do not use topical steroids on the rash, although the use of topical steroids can be considered in extreme cases where the infection has gotten itchy and inflamed.¹¹ Children, who are diagnosed with tinea manuum, do not need to stay away from school, instead, they can practice good hygiene to prevent it from spreading.

If you are experiencing recurring symptoms of tinea manuum, consider consulting your GP as there could be other underlying issues that could be causing frequent infections. Oral medications or injections might be considered if topical treatment does not work or the fungal infection has worsened.¹² 

Long-term strategies to prevent recurrence 

Consistent hygiene routine

It is recommended to continue good hygiene practices even after symptoms disappear. This is to prevent tinea manuum from reoccurring. One way to practice good hygiene practices is to wash your hands thoroughly, especially after being in contact with animals or soil. If possible, wear protective gloves when working with soil or animals. Look out for other fungal infections, such as tinea pedis (ringworm on the feet) or onychomycosis (fungal infection of the feet), and treat them to reduce the likelihood of reinfection. Certain occupations require extensive hygiene routines, for example, the sports industry requires proper cleaning of equipment and sports mats and farmers who work with soil should wear proper protection and regularly bath to prevent infections.

Lifestyle modifications

The Centers for Disease Control and Prevention (CDC) have a few lifestyle modifications listed below:

• Maintaining dry and clean skin¹³ 
• Wearing shoes that are properly ventilated to prevent tenia pedis, which can subsequently lead to tinea manuum⁶
• Wearing footwear around shared spaces such as locker rooms and communal showers
• Keep your fingernails short and clean (fungi can grow between the nail and the nail beds)
• Change underwear and socks at least once a day
• Try not to share your personal items such as clothing, bedding and combs

Some other measures include avoiding prolonged moisture exposure, such as not wearing gloves for too long, especially when sweating.¹³ You can also boost your immune system through balanced nutrition and by trying to reduce stress, which can affect your immune system. 

Summary

Ongoing prevention minimises the risk of recurrence and ensures long-term skin health. The main prevention measures that can be taken to prevent tinea manuum include good hygiene practices including washing your hands regularly and bathing regularly. It is also recommended to wear protective gear when handling soil or pets with ringworm as well as wearing footwear in communal showers and locker rooms where ringworm commonly spreads due to highly damp conditions. People are discouraged from sharing personal items such as towels, combs and bedsheets. The sports environment has a higher risk of transmitting fungal infections, which is why it is recommended to clean your gym equipment and sports mat, and athletes are recommended to shower straight after training. It is also recommended to keep the skin clean and dry by using anti-fungal powders. It is important to prevent the recurrence of tinea manuum as it is a highly contagious infection and can spread uncontrollably if intervention does not happen. 

FAQs

What is the difference between tinea manuum and dermatitis?

The main difference is the physical appearance between the two, tinea manuum has more raised edges and a clear middle, while dermatitis has more patches of rashes. Dermatitis tends to be itchier and requires topical steroids. Unlike dermatitis, tinea manuum only affects one hand while dermatitis can occur on both hands.¹⁴

What happens if tinea manuum is left untreated?

If left untreated, tinea manuum can cause serious complications such as ulcers or cellulitis, and it can also spread to the rest of the body as it is highly contagious. It can also spread to the nails which can be harder to treat with topical treatment and will require further medications such as injections and oral medications.

Why is my fungal infection not going away?

This could be due to improper use of topical treatment, like skipping applications which will not completely treat the infection. Another reason could be due to anti-fungal resistance, where some fungi are resistant to anti-fungal treatment. It could also be due to immunodeficiencies, which can make you susceptible to tinea manuum.² It is best to seek medical advice at the pharmacy or see your GP if your symptoms do not go away.¹⁵