Tinea Manuum and Tinea Unguium

For about 4 months, a very dry, diffuse, fine scaly, asymptomatic eruption covered the palms of a 28-year-old man; several fingernails were dystrophic bilaterally as well. Before the onset of this condition, bilateral onychomycosis of the toenails had been diagnosed. The toenails had not been treated and were still affected at the time of presentation. Branching hyphae were seen on a potassium hydroxide preparation of a fingernail cutting. The patient had tinea manuum and tinea unguium.

The presentation of tinea manuum is similar to that of tinea corporis. Both conditions typically arise as a flat, scaly lesion that eventually manifests a raised, rounded border. The border gradually enlarges, with clearing of the center, and may develop red papules or vesicles. Central areas become brown or hypopigmented and may have large papules. The lesion can be as small as a centimeter in diameter or cover large areas. Manifestations of tinea of the palm are similar to those of tinea of the sole; a dry, keratotic appearance may result from heavy manual labor.

Often, tinea manuum and tinea pedis coexist. In such cases, usually 1 foot and 2 hands or 2 feet and 1 hand are involved.

A 3-month course of oral terbinafine eradicated this patient's hand and nail infections.