Tinea Manus, Tinea Pedis

A 45-year-old man had a red, somewhat annular, slightly scaly plaque studded with red nodules that covered the back of his right hand. Nail dystrophy was evident on the middle finger. The patient's left hand was free of lesions, but the soles of both feet were slightly red and scaly, and there was an annular, serpiginous border on the left foot.

Potassium hydroxide (KOH) preparations of scrapings from the affected areas revealed hyphae consistent with dermatophytosis, and Dr Reynold C. Wong of Sacramento, Calif, made the diagnoses of tinea manus and tinea pedis, respectively. Also noted on the patient's foot was Majocchi's granuloma, a nodular perifolliculitis caused by dermatophytes. He was successfully treated with a 1-year course of oral griseofulvin.

The diagnosis was not as simple when a 27-year-old woman presented with a scaly, vesicular dermatosis on the palm of one hand. This rash was initially believed to be eczema, but it did not respond to repeated courses of potent topical corticosteroids. A KOH preparation was then examined, and the diagnosis of tinea manus was made. The patient responded well to twice-daily treatment with an antifungal cream, and the rash cleared in 4 weeks. She also proved to have tinea pedis, which is currently well controlled with a topical antifungal agent.

Dr Wong cautions that “recalcitrant hand eczema” that fails to respond to potent corticosteroid cream should be evaluated further to rule out a fungal infection, especially if only one hand is involved. A KOH preparation or a culture is confirmatory.