Introduction

Tinea manuum, also known as ringworm, affects the skin of a person’s hands.^1,2,3 Even though it is named ringworm, the infection is caused by a fungus and not by worms.^1,2,3

Depending on where you are in the world, tinea manuum affects between 0.3%-13% of people.³ Due to this, it is important to understand how it is spread to prevent people from contracting the fungus.

Tinea manuum

Tinea manuum is a fungal infection that affects the palms and the backs of your hands, and the skin between the fingers.^1,2,3 If not treated, it can spread to infect the fingernails.² It can be treated and does not normally cause any long-lasting problems.² Usually, only one hand is affected, although a patient can have tinea manuum on both hands.³ It is important to treat tinea manuum, because if left untreated, it can spread to other body parts like feet, scalp and groin.^1,3 

Symptoms of tinea manuum

The most common symptom of tinea manuum is round patches on the skin with a raised, flaky border.¹ The slightly elevated circle looks like a worm that’s in the shape of an “O,” which is how the condition got the name “ringworm.² 

On people with paler skin, the affected areas will usually look pink or red. In people with darker skin tones, it may be more difficult to see and can look like a darker patch of skin or grey.¹ The rash causes the skin to become so dry that it seems scaly. Often, the area is itchy and may become swollen.¹

Who is at risk of tinea manuum?

Tinea Manuum can affect anyone, but some people are more likely to get infected than others.³ A person is more likely to get tinea manuum if:^2,4,5

• If they have hyperhidrosis (a condition where you sweat more than normal) 
• If they live, or have visited, somewhere that is hot and humid
• If they are overweight
• If they use public facilities, for example, showers and changing rooms
• If they have atherosclerosis (a condition where fat inside the blood vessels means that blood cannot flow as well as it should)
• If they live in shared accommodation, like dormitories or hostels
• If their immune systems are not as strong as usual, for example, due to being HIV-positive, certain cancer treatments or having diabetes
• If they play sports which involve touching other people, for example, rugby
• If they have high blood pressure
• If they share things with other people, like gloves for certain sports or bedding
• If they are assigned male at birth
• If they work in certain jobs that involve touching other people, soil, animals, or chemicals. These jobs include car mechanics, vets, gardeners, and masseurs

Diagnosing tinea manuum

Due to the ease with which tinea manuum can spread on a person’s body as well as to other people and due to the itching and discomfort it can cause, it must be diagnosed and treated.³

A doctor will do several things to work out if their patient has tinea manuum.

Taking your history

The doctor will ask their patient about their history, including their job, living situation, hobbies and travel history to see if they are likely to have caught tinea manuum.³

Dermoscopy

Doctors sometimes examine skin with an instrument called a dermatoscope. This tool magnifies what the doctor is looking at by up to ten times, allowing them to see the skin in closer detail. This means that the healthcare professional can sometimes see the little white scales on the skin that happen when a person has tinea manuum.

Potassium hydroxide staining

A medical team will sometimes take a sample of the patient’s skin and send it to a laboratory to be tested.^2,6

The lab worker will add potassium hydroxide solution to the skin sample and then examine it under a microscope. The potassium hydroxide makes it easier to see the fungus, which means that it can then be diagnosed.

Culture

This is a test where a sample of the fungus is encouraged to grow under laboratory conditions. This means that there will be more of the fungus to examine, which can help the medical professional diagnose what is causing the problem.

Treatment of tinea manuum

Tinea manuum can be treated with antifungal medication. These can be found at most pharmacies, or they can be prescribed by your doctor.

The medications kill the fungus and can come in many forms. Some of these are:¹

• A spray that can be put on the skin
• Tablets to be swallowed
• Gel is to be put on the affected area
• Cream to apply to the rash 
• Shampoo is to be used if it is affecting the scalp

People with tinea manuum are required to use the medicine for four to six weeks. The treatment must be completed, even if the rash seems to be improving, because if it is not taken, the problem will return.¹ 

How does tinea manuum spread?

People catch tinea manuum by touching something that is infected with the fungus. This is easily done as the organism can live for a long time away from a host, especially in places which are warm and wet (for example, in a shower).

Direct contact with humans

If a person touches someone else who has tinea manuum, then they can also catch the infection. This is known as direct contact. 

Examples of direct contact include contact sports, such as wrestling; jobs that require people to touch clients, such as hairdressers and massage therapists.⁷ 

Not everyone who has tinea manuum will have symptoms present at the time of contact, so they may not know that they have it, but they can still pass it on to others.²

A person can also spread it across their own body. For example, if you have a fungus infection on your foot and scratch the infected skin, it can then infect your hands.²

Indirect contact

If you touch something that has the fungus on it, then you can develop tinea manuum. This can be from things such as a towel after washing hands, sports equipment like weights in a gym, or manicure sets.²

Animals

Animals can have tinea manuum. This is especially true for young animals such as kittens and puppies, or animals found on a farm.

If a person touches these animals, for example, while grooming a pet or for agricultural work, they can pick up tinea manuum.²

The environment

Soil may have the fungus containing tinea manuum, so a person can pick it up this way, for example, from gardening or walking barefoot outside.²

Avoiding tinea manuum

There are strategies that you can use to prevent tinea manuum. These include:²

• Shower immediately after playing sports that involve touching others
• Do not share your sporting equipment with any other player
• Wash your hands often and make sure to dry them completely
• Nails that are kept short and clean are better for avoiding tinea manuum
• Wash your hands straight away after you come into contact with animals
• If your pet has a fungal infection, take them to the vet so that it can be treated before it passes the problem on to you
• Wash your hands after touching your feet
• If you have another fungal infection, e.g. Athlete’s Foot, treat this quickly so that it does not infect other parts of your skin

Summary

Tinea Manuum is very common and can affect anyone, though some people are more likely to develop it than others. It spreads very easily from contact with people, animals, infected items, or soil that contains the fungus. Tinea manuum is treatable and does not usually cause long-term symptoms, though it is best to avoid it if possible. It is usually treated with antifungal medicines such as creams, sprays, or tablets. The prevention of this condition can be done by following good hygiene practices, treating other fungal infections promptly, and avoiding sharing contaminated items.