Overview

Tinea manuum, commonly known as ringworm of the hand, is a fungal infection that affects the skin on the hand caused by dermatophytes.¹ The infection can affect the palms, the back of the hands, the spaces between the fingers, and even the fingernails. The infection can cause dry and thickened, or red and scaly rash.² This article focuses on the role of proper hygiene (regular hand washing and thorough disinfection) not just to prevent tinea manuum, but to manage it effectively and keep it from coming back.

Causes and risk factors

Dermatophytes are the primary cause, with Trichophyton rubrum being the most common.³ Dermatophytes are fungal organisms that need keratin for growth. These fungi can cause infections on the surface of the hair, skin, and nails. Dermatophytes are spread by direct contact from other people, animals, soil, and from fomites. The prevalence of dermatophyte infections in the skin is estimated to range from 0.8% to 12.6%.³ However, in different geographical locations, other aetiologic organisms have been reported. These include the following: 

• Trichophyton mentagrophytes
• Epidermophyton floccosum
• Trichophyton verrucosum
• Trichophyton interdigitale
• Microsporum canis – from a cat or dog

Overall, the fungi causing Tinea manuum thrive in warm and humid environments, particularly in tropical areas.¹ Tinea manuum is highly contagious and can be caught from various sources including:⁴

• Direct contact: The infection can be transmitted through direct skin-to-skin contact with an infected person. For example, shaking hands or touching the skin of someone with tinea manuum can lead to the spread of the fungus
• Indirect contact: Fungal spores can live on surfaces for extended periods, making it possible to catch the infection by touching contaminated objects or surfaces. Shared items like towels, clothing, shoes, or gym equipment can easily spread the infection
• Animal contact: Tinea manuum can also be transmitted through contact with infected animals. Fungi like Microsporum canis, which infect both animals and humans, can transfer the infection to people handling infected pets or animals
• Autoinoculation: This occurs when a person spreads the infection from one part of their body to another. For instance, someone with athlete's foot may accidentally transfer the fungus to their hands by touching their feet and then touching other areas

Risk factors

The development of tinea manuum is influenced by several factors, including the fungus itself, the person’s health, and environmental conditions.^4,5 Key risk factors include:

• Weakened immune system: Conditions like diabetes, hypertension, and chronic illnesses increase the risk of severe or recurring infections
• Moisture and friction: Areas like the groin, armpits, or between the fingers are more susceptible due to sweating, rubbing, and an alkaline pH
• Environmental factors: Warm, humid conditions and tight clothing or shoes that trap moisture create ideal conditions for fungal growth
• Biological sex: People assigned male at birth (AMAB) are generally more prone to fungal skin infections than those assigned female at birth (AFAB)
• High-risk environments: Humid places like communal baths, gyms, and public sports facilities increase exposure to fungi
• Occupation: Jobs involving hand trauma (e.g., mechanics) or animal exposure (e.g., farmworkers, pet owners) raise the risk of infection.More likely in those with manual labour jobs who sweat profusely (hyperhidrosis) or those with hand dermatitis
• Autoinoculation: Scratching infected areas, such as the feet, and touching other parts of the body can spread the fungus to the hands

Once the fungus touches the skin, it attaches almost immediately and burrows into the outer layer by breaking down keratin. This triggers the body’s immune response, though the fungus can suppress this response, making it harder for the body to clear the infection.

Signs and symptoms of tinea manuum

Tinea manuum, like other dermatophyte infections, can present in various ways.³ Itching was the most common symptom (75.7%), while palm-scale (85.9%) was the most prevalent clinical finding.⁸ The infection typically affects one or both hands, and symptoms may include:

• Dry and scaly skin: The most common sign is the appearance of dry, thickened, and scaly patches, which may be localised to certain areas of the hand or spread across the palm, back of the hand, or between the fingers
• Itching and redness: Itching, discomfort, and redness often accompany the infection. These symptoms can range from mild to severe depending on the extent of the infection
• Blisters: In some instances, small blisters or cracks may develop on the skin, particularly if the infection becomes more severe or is left untreated
• Nail involvement: In rare cases, tinea manuum can also affect the fingernails, causing them to become discoloured, brittle, or thickened

Role of hygiene in preventing tinea manuum

Handwashing

Handwashing is one of the most effective practices to prevent the spread of tinea Manuum.⁶ The effectiveness of handwashing in preventing the spread of diseases was discovered in the early 19th century. Regular and effective handwashing with soap and water for at least 15 to 20 seconds vigorously on all surfaces of the hands and fingers reduces the spread of fungal spores, lowering infection risk and healthcare costs. The World Health Organisation details hygiene practices “that help to maintain health and prevent the spread of diseases”.⁷

Hand hygiene: The first line of defence

Improving hand hygiene can help reduce the spread of infections and lower healthcare costs associated with hospital-acquired infections (HAIs). Better hygiene habits may also lead to fewer outbreaks of infectious diseases.^1,8,9 According to a comprehensive review, hand hygiene practices significantly decreased the pathogens on hands, which in turn decreased infection rates in hospital settings.⁹ Frequent handwashing is especially important in communal environments such as schools, healthcare settings, and gyms. In these settings, fungal spores can easily spread through shared surfaces, making hand hygiene even more critical to prevent outbreaks.¹ To prevent the occurrence of infections, affected individuals should avoid sharing personal items, wear footwear in public showers and pools, and regularly change socks and alternate shoes to keep feet dry.¹⁰

Disinfection: A key step in preventing reinfection

The transmission of tinea manuum within households is relatively low, with a rate of 4.4%.¹¹ However, the risk rises in larger households, emphasising the importance of proper hygiene and disinfection. To prevent the spread, itis essential to treat infections promptly and regularly disinfect shared surfaces, personal belongings, and high-contact areas to reduce environmental contamination.¹¹

Preventative measures

In addition to personal hygiene, other steps can help prevent tinea manuum. By making smart choices in daily habits, you can reduce your risk and avoid reinfection. Here are some easy and effective measures to follow:^1,10,11

• Choose comfortable, breathable clothing: Opt for loose-fitting, breathable clothes and shoes to keep your skin dry and prevent fungi from thriving in warm, damp environments
• Resist scratching: If you have tinea pedis (athlete’s foot), scratching can transfer the fungus to your hands and other areas of your body. Keep your hands off infected areas to prevent spreading the infection
• Early intervention: The sooner you treat any fungal infection, the less chance it has to spread. Early treatment is key to stopping the infection from travelling to your hands or other parts of your body
• Avoid steroid creams: Steroid creams may temporarily relieve itching, but they don’t address the fungal infection and can delay proper treatment. Use them only if recommended by a healthcare provider
• Personal items: Avoid sharing personal belongings like towels, shoes, and clothing. Fungi can spread easily through shared items, so it is best to keep them to yourself to prevent infection
• Contact with animals: After handling animals, wash your hands thoroughly. If your pet shows signs of a fungal infection, take them to a vet to avoid passing it on
• Sports: After sports practices or games, shower as soon as possible. Disinfect and avoid sharing equipment to reduce the risk of fungal infections

Diagnosis 

Tinea manuum can be difficult to distinguish from other skin conditions that cause similar symptoms.¹² It often resembles conditions like eczema, psoriasis, contact dermatitis, and pityriasis rosea. Accurate diagnosis is essential to differentiate between these conditions and ensure proper treatment.¹³

Wood's light examination

Wood's light examination helps rule out other skin conditions by highlighting fungal infections. While tinea manuum doesn’t always fluoresce, the test can assist in confirming the infection and checking for its spread. It can also help differentiate tinea from other conditions that may look similar under UV light.

Microscopy

Microscopy is the most common and reliable method for diagnosing tinea manuum. A sample from the infected skin is examined under a microscope to look for fungal hyphae, which confirms a dermatophyte infection. This test is quick, highly sensitive, and allows doctors to begin treatment immediately.

Culture

Culture is less commonly used but may be necessary if the infection is persistent or difficult to treat. It helps identify the specific fungus causing the infection, which is important for selecting the right treatment, particularly in cases that are recalcitrant or recurrent.

These diagnostic methods help ensure that tinea manuum is correctly identified and effectively treated, while also differentiating it from other skin conditions with similar appearances.

Summary

• Tinea manuum is a fungal infection of the hands caused by dermatophytes. It is commonly spread through direct contact with infected people, animals, or contaminated surfaces, especially in warm and humid environments
• Several factors can increase the risk of developing tinea manuum, including biological sex, underlying health conditions, exposure to moist environments, and certain occupations that involve frequent hand contact or animal handling
• Symptoms can vary but often include a ring-shaped rash, peeling, dryness, blisters, itching, and burning sensations. In severe cases, the infection can affect the fingernails
• Diagnosis involves a physical examination, medical history, and laboratory tests, such as direct microscopy and fungal cultures
• Treatment generally involves topical and oral antifungal medications. In some cases, corticosteroids may be prescribed alongside antifungals, depending on the infection's severity
• Early diagnosis and treatment are important to prevent complications like bacterial infections, lymphangitis, and skin reactions