Hand Fungus: Information & Hand Fungus Specialists

Tinea manuum (also known as tinea manus) refers to a fungal infection of the hand. The term comes from Latin: “Tinea” refers to skin fungi in general, while “manuum” or “manus” means “of the hand” or “hand.” The root “manus,” meaning “hand,” is used in common words such as “manual.”

In addition to tinea manuum, there is also tinea pedis, the classic athlete’s foot, and tinea capitis, ringworm of the scalp.

Hand fungus is caused by dermatophytes, which are various types of filamentous fungi. The specific causative agents are usually

• Trichophyton rubrum or
• Trichophyton mentagrophytes,
• less commonly Epidermophyton floccosum.

Fungal skin infections are, overall, a very common condition. Depending on the source, up to 75 percent of all people are affected at some point. Athlete’s foot and nail fungus, in particular, account for a large portion of this enormous prevalence.

Hand fungus is significantly less common. However, there are no exact figures available.

There is no single, clear cause of hand fungus. Dermatophytes are found everywhere in the environment. They can

• be transmitted from person to person,
• from animals to humans,
• through contact with soil, or
• through transmission in public facilities such as
  • public showers,
  • swimming pools,
  • gyms,
  • sports mats,
  • gyms, and so on

.

On healthy skin, infection usually does not occur despite contact with pathogens. For an infection to develop, additional predisposing factors are necessary, such as

• an immature immune system in children,
• chronic conditions such as diabetes, or
• peripheral arterial disease with circulatory disorders.

The working hand—or, in the case of athletes, the sports hand—is strikingly often affected by athlete’s foot. This hand

• has the most contact with fungi in the environment and
• is most susceptible to damage from mechanical stress.

Damage to the skin barrier can also serve as an entry point.

Hand fungus is also very often associated with athlete’s foot or nail fungus: The foot is affected by fungal infections significantly more frequently. The fungus is then transmitted to the hand through contact between the foot and the hand.

Hand fungus usually occurs on one hand only. The basic signs of a skin infection are always

• redness,
• a rash,
• itching,
• and sometimes flaking.

Specifically, a distinction is made between

• dyshidrosiform tinea manus and
• hyperkeratotic rhagadiform tinea manus

Dyshidrosiform tinea manus causes unpleasant, itchy pustules and blisters on the palms and fingertips. 

Hyperkeratotic rhagadiform tinea manus is characterized by

• reddish scaling and
• rhagades on the palms and fingertips

. Rhagades are fissures in the skin that can be extremely uncomfortable. Furthermore, they can serve as entry points for bacterial superinfections.

If the back of the hand is affected by tinea manus, reddish lesions with well-defined borders usually form. This is typical of generalized tinea (tinea superficialis).

As the condition progresses, the lesions spread across the entire palm. Scaling and rhagades also occur. At this stage, the function of the hand is also severely impaired. As a result, grasping objects can be difficult and painful.

Hand fungus is highly contagious. Any contact can spread the pathogen to other

• parts of the body,
• people, or
• surfaces

.

A visit to your family doctor or dermatologist is recommended in every case.

Athlete's foot causes circular, reddish patches that often develop flaky skin © darkhriss | AdobeStock

In most cases, the doctor makes a visual diagnosis. In other words, they can recognize hand fungus based on the symptoms alone. The diagnosis is particularly clear if the patient also has severe athlete’s foot.

If the diagnosis is unclear, the doctor may take a swab and examine the sample under a microscope.

However, taking a medical history is still important when dealing with a fungal skin infection. The doctor will ask about predisposing conditions such as peripheral arterial disease (PAD) or diabetes mellitus.

In addition, a number of differential diagnoses may be considered for the redness of the hand and the itching. These include

• atopic eczema (neurodermatitis) with a general tendency toward skin eruptions,
• psoriasis of the hands, and
• allergic contact dermatitis.

Furthermore, there are rare skin conditions such as dyshidrosis or hereditary palmoplantar keratosis. These can usually only be properly diagnosed and treated by a dermatologist.

Using a Wood’s lamp—a type of UV lamp—some fungal pathogens can be identified by their fluorescence.

If the diagnosis is unclear, the physician will perform a culture. For this, the tissue sample is cultured in the laboratory so that the exact pathogen can be identified. This is the only way to classify the exact strain more precisely. A culture can take three to six weeks.

One advantage of culturing is that it allows the effectiveness of various antifungal medications (antimycotics) to be tested. Any resistance can also be detected this way. This enables the treatment to be precisely tailored to the individual case.

A fungal infection of the skin is generally treated with antifungals. These are medications that target fungi. Depending on the active ingredient, they either prevent the fungi from multiplying or kill them.

The skin is, by nature, a barrier that is difficult to penetrate. Inside the skin, fungi can hide well as spores that are resistant to the environment. This makes them relatively difficult to kill. With nail fungus, the situation is even more challenging.

Local Treatment of Hand Fungus

Hand fungus therefore requires long-term, continuous, and consistent treatment. It takes three to four weeks for the outermost layers of skin to completely shed and regenerate. Antifungal medications aim to prevent fungal reproduction and growth over this period. If this is successful, the hand fungus is defeated.

This usually involves the use of ointments or solutions that the patient applies to the affected areas. This is referred to as local or topical therapy (topical means “on the spot”). In most cases, topical therapy is sufficient for hand fungus. It can be carried out using various agents such as 

• azole derivatives (e.g., bifonazole, clotrimazole, econazole, sertaconazole, tioconazole),
• hydroxypyridones (ciclopirox),
• allylamines (e.g., naftifine, terbinafine), or
• morpholines (amorolfine)

.

Treatment must be followed consistently for the specified duration. Otherwise, the patient risks a relapse. In most cases, treatment relieves symptoms very quickly—which indicates that the medication is working. However, fungal spores remain in the skin and can regrow once the medication is discontinued.

Systemic treatment for athlete’s foot

If topical treatment is ineffective, “stronger measures” must be taken. This is particularly common in infections of deeper skin layers and in the hyperkeratotic form of hand fungus.

The treatment is then shifted to the body. The patient takes tablets whose active ingredients act throughout the entire body.

Antifungal medications include azoles, terbinafine, or griseofulvin. The latter is rarely used anymore. However, griseofulvin is the only antifungal medication of its kind that is approved for use in children. Fluconazole may be used in children (older than one year) only if there is no alternative.

The systemic administration of most antifungal medications has the disadvantage that they can damage the liver. In addition to a healthy liver being a basic requirement, a blood test should therefore be performed at least once during the course of treatment.

Contamination with fungal pathogens cannot be completely avoided. They are present everywhere and at all times.

However, certain hygiene measures can significantly reduce the risk of infection.

Almost all dermatophytes can be reliably killed with disinfectants. It is therefore worth disinfecting your hands and feet in public swimming pools or gyms.

Wash regularly and avoid damp, warm environments—especially in athletic shoes—for extended periods of time.

Children are particularly susceptible because their immune systems are not yet fully developed. It is important to ensure consistent personal hygiene for them. They should therefore avoid contact with people who have athlete’s foot.

Other individuals at higher risk, as mentioned above, should also avoid contact with those affected.