Correctly distinguish between tinea manuum and hand eczema, and symptomatic treatment will be more effective!

Hands are important organs of the human body, but because there are too many contact surfaces, they will inevitably bring some troubles. For example, if you scratch the itchy area caused by ringworm, the fungus may be transmitted to the hands and cause ringworm. If you come into contact with external allergens or chemical substances such as soaps, disinfectants, detergents, etc., it is easy to cause hand eczema.

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Both tinea manuum and hand eczema can cause uncomfortable itching symptoms on the hands, but there are differences between the two in terms of clinical symptoms and treatment.

1. The causes of tinea manuum and hand eczema are very different

Tinea manuum is caused by dermatophytes on the curved surface of the fingers, fingertips and both sides of the palm. It usually occurs on a single palm, and the first site of the disease is often the thumb. In severe cases, it may spread to the back of the hand and the foot. The itching symptoms are not too obvious at the beginning. Tinea manuum will worsen in spring and summer, and will be significantly relieved in autumn and winter.

Hand eczema is an itchy, inflammatory skin reaction caused by a variety of internal and external factors. It usually occurs on the back and palm of the hand, and is usually symmetrical on both hands. Most patients with hand eczema have allergic constitutions. The hands are often exposed to a variety of external allergic factors, such as disinfectants, detergents, and chemical products, which leads to the onset of the disease.

In addition, tinea manuum is highly contagious and can be transmitted between people, animals, and fomites. Skin contact, sharing shoes and socks, sharing washbasins and towels, and touching public items in public bathrooms and swimming pools can all lead to fungal transmission, and can also spread between different parts of the patient's body [1]. Hand eczema is not contagious.

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2. How to distinguish between tinea manuum and hand eczema

Both tinea manuum and hand eczema occur frequently in the summer. Patients initially experience unbearable itching somewhere on their hands. The two are easily confused, so it is necessary to understand the specific symptoms of tinea manuum and hand eczema in order to treat them symptomatically.

The fungal test results of patients with tinea manuum are positive, while those of patients with hand eczema are negative. This is a favorable basis for judging whether it is tinea manuum or hand eczema.

Tinea manuum usually occurs unilaterally, especially in the summer. Initially, needle-sized blisters develop from a certain part of the hand, especially the palm, the curved surface and the side edge of the index finger or thumb. The blisters gather in groups or are scattered, and the patient feels itchy. Afterwards, the blisters dry up and desquamate, and the lesions spread to the surrounding areas, forming annular or polycyclic lesions, usually manifested as flaky erythema with small papules on the edges, which may affect all fingers, palms and the base of the thumb [1]. Such patients often have severe tinea pedis or onychomycosis.

Hand eczema is manifested as dark red spots, and the rash occurs symmetrically. The patient's skin surface is dry and rough, with thick keratinization. Patients often experience itching and cracked skin in winter, which can be painful. If exposed to allergens, erosion and exudation are also likely to occur.

Treatment of tinea manuum and hand eczema

For hand eczema, doctors generally ask the patient's medical history in detail to find possible pathogenic factors. In daily life, patients should try to avoid direct contact with chemicals, detergents, dirt, and substances they are allergic to, avoid long-term wet or dry hands, avoid contact with hot water and scratching with hands, and avoid eating irritating foods. Hormone ointments can be used externally to treat hand eczema, but the early treatment effect is better, and it is easy to relapse later.

Antifungal drugs should be used to treat tinea manuum. The goal of treatment is to eliminate pathogens, quickly relieve symptoms, and prevent recurrence.

Depending on the clinical symptoms and severity of tinea manuum, topical medications, oral medications, or a combination of both can be used.

1. For mild or early stage tinea manuum, topical antifungal drugs can be used for treatment, such as imidazole antifungal drugs, acrylamine antifungal drugs and other antifungal drugs.

2. Patients can take oral medications to treat tinea manuum. This method has the characteristics of short treatment course, convenient medication, no missing lesions, high patient compliance and low recurrence rate.

3. For patients with large affected areas, poor local treatment effects, macerated and erosive types, stubborn, and multiple recurring tinea manuum, combined treatment can also be used to improve efficacy and shorten the treatment process. The commonly used method is to combine a topical medication with an oral medication. It is also possible to choose a combination of two topical medications with different antifungal mechanisms, but the specific use of the medication requires the guidance of a professional doctor [1].

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Both tinea manuum and hand eczema are prone to occur or relapse in warm and humid environments, so it is very important to understand the causes, clinical symptoms and preventive measures of both.

On the premise of maintaining good personal hygiene, patients should also pay attention to adjusting their own living habits so as not to give these two factors an opportunity to take advantage.

References

[1] Chinese Tinea Manuum and Tinea Pedis Diagnosis and Treatment Guidelines Working Group. Chinese Tinea Manuum and Tinea Pedis Diagnosis and Treatment Guidelines (Popular Science Edition 2022) [J]. Chinese Journal of Mycology, 2022, 17(2): 89-93.

Reviewer: Zhang Shuyuan, Chief Physician, Beijing Huayi Integrated Traditional Chinese and Western Medicine Dermatology Hospital