Tinea Manuum in a Rancher

For years, a 39-year-old man had an eruption on his hand, which seemed to be controlled with topical corticosteroids. The patient was a rancher.

The lesion's well-defined annular, scaly border raised suspicion of tinea manuum, which was confirmed by a potassium hydroxide evaluation. His occupation suggested that livestock were the likely source of the infection. Chronic hand eczema and psoriasis had also been considered in the differential. The patient's use of corticosteroids had exacerbated the infection and made it more difficult to diagnose and treat.

A 2-week course of oral terbinafine, 250 mg/d, plus a topical imidazole used for 1 month resolved the infection.