Introduction 

Skin infections are a major challenge for athletes, particularly those involved in contact sports. While they may be a minor inconvenience to the average person, cutaneous infections can have serious consequences for athletes, including disqualification from practice or competition, which is a common concern in sports such as wrestling.¹ Fungal infections are one of the most common skin disorders affecting athletes, with tinea infections being the most commonly reported.² Infections could be due to the constant exposure to showers, locker rooms, and sweaty gear that create a perfect environment for fungi to thrive. Additionally, close contact, shared equipment, and tight clothing further increase the risk.

While tinea pedis (athlete’s foot) is the most common tinea infection among athletes, tinea manuum is another infection to be aware of. Tinea pedis makes up around 15% of fungal infections and often goes hand in hand with tinea pedis, usually because of direct contact with infected feet.

Understanding tinea manuum

What is tinea manuum?

Tinea manuum is a fungal infection that is usually itchy and presents as a scaly rash in a round patch on the back of your hands, palms, or between your fingers. Tinea manuum mostly affects one hand (unilateral); however, both hands may be affected.³ Tinea manuum mostly occurs alongside tinea pedis, with the most common being the ‘two feet, one hand syndrome,’ where both feet and one hand are affected. However, tinea manuum can present on its own.

What causes tinea manuum?

Tinea manuum is caused by dermatophytes, a kind of fungus that grows quickly on the skin. The most common dermatophytes include Trichophyton rubrum, Trichophyton mentagrophytes, and Epidermophyton floccosum.³ These fungi spread through direct contact with infected skin or contaminated surfaces, such as gym equipment, towels, and gloves. Athletes are more likely to contract the infection due to frequent skin contact and exposure to shared surfaces.⁴

Risk factors for tinea manuum in athletes 

Athletes, especially those involved in contact sports, face a higher chance of contracting tinea manuum because the environment that comes with these sports creates the perfect opportunity for fungi to thrive and spread. Reasons that increase the spread of tinea infections include:

Close physical contact

The dermatophytes involved in tinea manuum infections thrive on keratin, which is found on the skin. Therefore, in sports where skin-to-skin contact is common, the chances of transmission increase. There are two main ways this infection could spread through physical contact:

• Direct contact: Here, there is prolonged and frequent skin-to-skin contact, especially in sports like wrestling or judo; this makes it easy for fungi to transfer from one person to another
• Indirect contact: Sometimes, the infection can spread from shared items, including towels, gym equipment, mats, and benches.⁵ Athletes training, using, or rolling on these surfaces may contract tinea infections in this process

Underlying health conditions 

Certain medical conditions can increase the risk of developing tinea manuum. Some include:

• Diabetes: People with diabetes could have high blood sugar levels, which can weaken the immune system and make the body less effective at fighting off infections⁶
• Weakened immune system: Athletes with weakened immune systems, such as those living with human immunodeficiency virus (HIV) or using drugs that suppress the immune system, including corticosteroids, are more likely to develop tinea manuum. Ultimately, their bodies are less capable of fighting fungal infections, allowing even minor infections, such as tinea manuum, to spread easily and take longer to heal

Other contributing factors

In addition to direct contact and health-related risks, the following factors could play a role in athletes developing tinea manuum:  

• Tinea pedis infection: Tinea pedis (athlete’s foot) is one of the most common infections in athletes. It is caused by the same group of dermatophytes responsible for tinea manuum. Tinea manuum can spread from the feet to the hands through autoinoculation (self-transmission of a pathogen from one part of the body to another), by scratching or touching the affected area. Therefore, autoinoculation could lead to the ‘two feet one hand syndrome', which is a common presentation of tinea manuum in athletes
• Walking barefoot: There is an increased risk of tinea infections for athletes who walk barefoot, particularly in public spaces such as gyms, locker rooms, and showers. These areas are usually warm and moist, which is the perfect environment for fungal growth
• Skin trauma: Fungi can enter the skin through minor wounds, such as cuts or scrapes, which are common in contact sports. Once the skin barrier is broken, it becomes easier for fungal spores to cause an infection

Symptoms of tinea manuum 

At first, tinea manuum presents as a rash that becomes increasingly itchy and scaly. As the infection progresses, the affected area thickens, becomes uncomfortable, and can develop cracks, blisters, and skin discolouration. In some cases, the infected area can become swollen and painful.

Diagnosis 

A healthcare provider can recognise tinea manuum by examining the affected area, which is called a clinical examination, and will ask about the patient's medical history and symptoms. However, this may not be conclusive, so further tests could be needed to confirm the infection, such as:

• Direct microscopy: Microscopy is a simple and inexpensive method to visualise the fungi. A healthcare provider may take a swab if the infected area is moist. If it is dry, they will gently scrape the surface. The sample is then treated with potassium hydroxide (KOH) to help spot the fungi
• Culture test: The sample can undergo a culture test to assess whether any fungi grow. Culture tests help identify the exact type of fungi causing the infection; however, this method takes approximately 2-6 weeks. It is recommended to begin treatment even before the results are obtained
• Fluorescent staining: For fluorescent staining, special dyes known as optical brighteners are used to make it easier to see fungal cells under specific lighting
• Dermoscopy involves using a handheld device that magnifies the skin to help identify patterns or features that suggest a fungal infection

Treatment/management 

There are different treatment options available for managing tinea manuum depending on the severity of the infection.

Topical antifungals 

Topical antifungals are often preferred because there is less risk of drug interactions and side effects, which could be seen with oral antifungals.³ The classes of drugs involved include:

• Azole antifungals: clotrimazole, ketoconazole, and miconazole
• Allylamines: terbinafine and naftifine
• Tolnaftate

Topical antifungals are usually applied once or twice daily for 2-6 weeks, depending on the drug and how severe the infection is. It is important to continue using the medication even after the symptoms disappear to ensure the fungus is completely eradicated.

Systemic antifungals 

Systemic antifungals are reserved for more serious infections, recurring infections, poor response to topical treatments, and in cases where there are other fungal infections like tinea pedis or onychomycosis. Some include:

• Terbinafine (usually 250 mg daily for  2 to 4 weeks)
• Itraconazole (usually 100-200 mg daily for 1 to 2 weeks)
• Fluconazole (often 150-300 mg once weekly for 2-4 weeks)

In addition to using antifungal medications, other strategies could help reduce re-infection and support recovery. These include:

• Keeping hands clean and dry
• Avoid the sharing of personal items
• Treating any coexisting infections to prevent autoinoculation

Prevention of tinea manuum in athletes

Athletes, especially those involved in contact sports, are at a higher risk of developing tinea manuum. Therefore, it is important to follow these preventative measures:

• Proper hygiene: Regularly washing hands with soap and water helps to remove fungal spores on the skin. It is essential to wash and dry your hands thoroughly after exercising or using shared equipment
• Avoid sharing personal items: Items such as towels, gloves, and mats can become easily contaminated and further spread the infection
• Treat tinea pedis properly: Since tinea pedis is a major cause of tinea manuum, treating it effectively can prevent the spread of the infection to the hands
• Avoid walking barefoot in public areas: these public areas can include showers, gym showers, and locker rooms.
• Keep hands dry: Drying your hands prevents tinea fungus from surviving on your hands because it requires a moist environment to thrive

Conclusion

Tinea manuum is a minor infection that can be easily managed with appropriate treatment, after which the athlete can readily return to play after a minimum of 14 days post-treatment.⁷ When treated early and with the right approach, complications like secondary infections or long-term fungal problems can be avoided. Understanding the infection, its causes, and how to prevent it is important in reducing its occurrence among athletes.

FAQs

Is tinea manuum contagious?

Yes, tinea manuum is contagious and can spread through direct contact with infected skin or contaminated surfaces.

How to prevent tinea manuum?

Tinea manuum can be prevented by maintaining good hygiene, keeping hands dry, avoiding sharing personal items, and treating athlete's foot promptly.

How is tinea manuum treated?

It is typically treated with topical antifungal creams, such as clotrimazole or terbinafine, or systemic antifungals, like fluconazole, for more severe cases.

Can you get tinea manuum from athlete's foot?

Yes, tinea manuum can develop from athlete's foot through contact with infected feet.

How long does it take for tinea manuum to heal?

It takes about 2-4 weeks for tinea manuum to heal, depending on the type of treatment.