Red, itchy and scaly. Could your hands have tinea manuum? If this sounds familiar to you, then keep reading this article. You may have a skin infection called tinea manuum, commonly known as ringworm. Unlike popular belief, it's not caused by a worm but rather by the fungi, dermatophytes, and only requires a course of antifungal medication. 

This article outlines the symptoms to look for when suspecting whether you or anyone around you may have tinea manuum. The 3 main takeaway points of this article are:

• Tinea manuum manifests as ring-like patches that are itchy, scaly, and red
• It can affect the palms, back of hands and in between the fingers, sometimes spreading to the nails
• It usually affects one hand more than the other, but it can also affect both

What is Tinea Manuum?

Tinea manuum is a fungal skin infection caused by dermatophytes, the most common one being Trichophyton rubrum.¹ It is thought to be diagnosed in 13% of all fungal infections, making it one of the most common skin infections caused by fungi.¹ There are many types of ringworm, and the specific name is given based on where in the body it can be found, in this case, on the hands, but you can also develop ringworm on your feet, nails, scalp, groin and body.²

Tinea manuum is not a serious condition and can be treated with over-the-counter oral antifungals. However, it is contagious and can lead to a more serious condition if left untreated. For this reason, it is crucial to recognise its symptoms.

What are the symptoms of tinea manuum?

Tinea manuum can be asymptomatic, but it is most common in its symptomatic form.³ While it can affect people of all ages and genders, it is more common in adult and adolescent people assigned male at birth.⁴ It can manifest in one or both hands³ and can appear in:

• Your palms
• The back of your hands
• In between your fingers

It also frequently manifests along with tinea pedis (athlete’s foot) in a “two feet one hand” pattern, where your feet are usually infected first and then transmitted to a hand after scratching.⁵

Ringworm manifests as a ring-like rash (think about a coffee cup stain on the table), with a raised border and a clear patch in the middle.^3,5 The three main symptoms include:

Scaling 

Often, the skin in the back of the hands and palms may get dry, thicken and present diffused white scaling (hyperkeratosis) as if you have just painted with white paint.^3,5 This white scaling is usually more evident in the palms of the hands. While you might think your hands just need hand lotion, you will find that ringworm doesn’t go away by moisturising. 

Itchy skin

If you have ever had athlete’s foot, the discomfort from itchiness is similar. This ranges from mild irritation to incredibly itchy patches.³ The itchiness can be persistent, and it can worsen with heat or sweat. While you may be tempted to itch away, be aware that itching can foment spread and lead to secondary bacterial infections.

Redness

The patch is ring-shaped, with bumpy edges. On light skin, the rash looks more pink or red, while on brown skin it looks more brown or grey. On occasion, when found in between the fingers, some blistering may appear that contains a clear fluid which is very itchy and burns.⁶

Secondary features

If left untreated, ringworm can spread and symptoms can worsen:

Progression of symptoms

Over time, the skin can end up thickening and cracking, causing painful fissures.³ The rash can also spread to other parts of the body and be transmitted to other people.

Nail involvement

Tinea manuum can spread to the nails (onychomycosis), especially if it affects the skin between your fingers.⁵ This can manifest as discoloured, brittle nails. In this case, oral antifungals such as terbinafine or itraconazole may be prescribed, as topical antifungals can’t penetrate the nail properly.

Risk of misdiagnosis

Tinea manuum is often misdiagnosed with eczema, psoriasis or allergic dermatitis.⁷ A key difference is that ringworm usually affects one hand more than the other, whilst eczema usually affects both. In cases where both hands are affected, the rashes look different in each hand, as opposed to symmetrical rashes with eczema.³ 

If you are unsure of your condition, visit a professional who can give you a specific diagnosis and correct treatment.

When to seek medical attention

Tinea manuum can be easily treated from home with over-the-counter antifungals such as clotrimazole and miconazole without the need to see a doctor. You can speak to your local pharmacist, who can recommend the best treatment for you. Usually, the treatment consists of an antifungal cream which can be applied directly to the hands, once or twice a day, for up to 4 weeks.

However, some infections may be more stubborn and require a doctor to prescribe a different treatment, usually consisting of oral antifungals such as terbinafine and itraconazole. 

Here are some red flags to look out for:

• Symptoms persist after antifungal treatment
• The rash is spreading to other areas of the body, such as the feet, nails, and groin
• You notice that the condition has worsened and can appreciate pus, severe swelling and even fever. This could be a sign of a secondary bacterial infection⁵

A doctor or a medic can perform cell culture and microscopy to obtain a final diagnosis and give you the correct treatment for your condition.⁶ In stubborn cases, a doctor may refer you to a skin specialist.

FAQs

What is tinea manuum?

Tinea manuum, commonly known as ringworm, is a fungal skin infection that affects the hands. It is caused by dermatophytes, commonly Trichophyton rubrum and is thought to affect around 20% of the global population.³ It is characterised by an expanding ring-like rash that is red, itchy, scaly and often blistery. Its most common manifestation is the “two feet one hand” manifestation, this is, along with athlete's foot.⁵

How can I get tinea manuum?

You can get infected with tinea manuum in several ways:⁸

• Direct skin-to-skin contact with an infected person
• Petting an infected animal, including cats and dogs
• Touching contaminated objects such as towels and clothes
• Using showers and pools, and not washing your feet afterwards
• Touching infected soil. This is particularly common among children

Is tinea manuum contagious?

Yes. Tinea manuum is contagious and can spread from person to person, animal to person, and through sharing contaminated objects.⁸ It can also spread from the primary affected area to other body parts such as the groin, nails, scalp and body.

Can tinea manuum be mistaken for other skin conditions?

Yes, tinea manuum can be mistaken for other skin conditions, including eczema, allergic dermatitis and psoriasis. A key difference is that while tinea manuum usually affects one hand, when it affects both, the rashes manifest in a non-symmetrical way, unlike eczema.

How is tinea manuum treated?

Tinea manuum can be treated with over-the-counter antifungals such as clotrimazole and miconazole. This can be done from the comfort of one’s house without visiting the doctor. To treat, you usually apply an antifungal cream to the infected area once or twice a day for the duration of the treatment, which can last up to 4 weeks. In the case of ringworm spreading to the nail or recurrent infections, your doctor may prescribe oral antifungals such as terbinafine and itraconazole, which come in the form of a pill.

How long does it take for tinea manuum to heal?

Tinea manuum usually heals within 4-6 weeks of using the antifungal treatment. It is important to complete the treatment as advised, even if your symptoms have gone, as fungal infections can be complicated to treat and even come back after treatment. You should see a doctor if the infection comes back after treatment.

Can tinea manuum go away on its own

No. Tinea manuum requires treatment to get rid of. If you don’t get it treated, it can spread.

How can I prevent tinea manuum?

• Wash your hands regularly
• Wash contaminated clothes or surfaces
• Avoid sharing with others
• Treat all infected areas
• Wear loose clothing

Summary

Tinea manuum is caused by the dermatophyte fungi and can manifest in the palms, back of hands or in between the fingers. It can also spread to the fingernails. The main symptoms are dry, itchy, and scaly white patches. Blisters can also appear, as well as deep cracks or thickening of the skin, if left untreated. Recognising these symptoms is crucial for their early detection and treatment.