My hands are dry and peeling. Do I have tinea manuum?

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

When the seasons change from autumn to winter, some people's hands will become dry and peeling. Although it does not hurt or itch, it affects the appearance.

This skin disease is called exfoliative keratolysis, and it usually resolves on its own without treatment.

But it should be noted that in addition to exfoliative keratolysis, tinea manuum can also cause similar symptoms in patients, and not only will it not heal automatically, it can also be contagious to others, which is very disgusting.

So how do you tell the difference between the two? Let’s first introduce exfoliative keratolysis.

1. What is exfoliative keratolysis?

Although the name of exfoliative keratolysis is very long, it actually refers to the phenomenon of natural shedding of the stratum corneum on the palm of the hand.

In the early stage, patients will have millet-sized white spots on their palms, which will then gradually expand to the surrounding areas, similar to the blister membrane with dried blister fluid. These white spots appear symmetrically on both palms, and in rare cases on the soles of the feet.

At this time, there is no obvious inflammatory change in the patient's hands, nor will there be any itching. The white spots can easily break naturally, or be habitually torn into thin paper-like dandruff by the patient, but this peeling phenomenon does not affect physical health.

However, when patients peel their hands, they are likely to break the skin, causing bleeding and pain. Moreover, once the skin loses its natural barrier of the epidermal stratum corneum, it is easy for some bacteria and viruses to invade and cause infection.

Therefore, if you find that your hands are starting to peel, be sure not to tear them off. At the same time, it is best for patients to temporarily refrain from doing housework such as washing clothes and dishes to avoid aggravating the symptoms.

The treatment of exfoliative keratolysis is also very simple. The patient only needs to apply urea ointment, vitamin E ointment, vaseline ointment and other oily ointments on the cracked and peeling skin. Urea ointment and vitamin E ointment can soften the stratum corneum, while vaseline ointment can moisturize and protect it. It should also be applied frequently after healing as a maintenance for the hands.

2. Causes of Exfoliative Keratolysis

The cause of exfoliative keratolysis is still unknown, but genetic factors and excessive sweating may be contributing factors.

In addition, the occurrence of exfoliative keratolysis is also related to the lack of zinc and vitamin A. Patients can eat more vegetables and fruits rich in vitamin A, such as spinach, tomatoes, oranges, etc. If children have peeling palms, they should be checked for trace elements in time, and those with severe cases need to seek medical attention in time.

Figure 1 Copyright image, no permission to reprint

Moreover, exfoliative keratolysis is more likely to occur during the transition from autumn to winter, so it is also related to the dry climate. In autumn and winter, the skin lacks moisture, metabolism is slow, the sebaceous glands function is reduced, and the skin surface is dry, so it is easy to crack and peel. Therefore, patients should drink more water to relieve dryness in the body and pay attention to moisturizing their hands.

In addition, laundry detergent, soap, and dishwashing detergent are also factors that cause the disease to worsen, and patients need to pay attention to protection when the disease occurs.

3. The difference between exfoliative keratolysis and tinea manuum

Tinea manuum can also cause peeling of the hands. This fungal infection can be transmitted between people, animals, and pollutants, and it is easy to get infected if you are not careful.

Tinea manuum is divided into two types: vesicular type and scaly keratotic type. The scaly keratotic type and exfoliative keratolysis are easily confused by patients.

Blistering tinea manuum

The onset of vesicular tinea manuum is usually unilateral. At the beginning, some needle-sized blisters will appear on the palm, flexor surface and lateral edge of the index finger or thumb. These blisters will gather in groups or be scattered, and the patient will feel obvious itching.

Soon after, the blisters will dry up and desquamate, and the skin lesions will spread around, forming ring-shaped or multi-ring-shaped lesions, which may affect all fingers, palms and the base of the thumb. If there is a secondary infection, pustules may form.

Scaly and keratotic tinea manuum

When scaly and keratotic tinea manuum begins, scattered small blisters will appear on the palms, followed by desquamation. Long-term patients will see thickening of keratinization. The lesions are mostly limited to one side, often starting from the palm, the flexor side of the second, third or fourth fingers, and the base of the thumb, and gradually involving the entire palm.

The lesions usually affect the palms, soles and heels, and are characterized by diffuse roughness, thickening, scaling and dryness of the skin. The pruritus is mild, and the skin often cracks and becomes painful in winter [1].

It can be seen that the symptoms of vesicular tinea manuum are obvious and can be easily distinguished from exfoliative keratolysis.

Scaly and keratotic tinea manuum only manifests as dry and flaky skin on the palms and soles, and the symptoms are particularly obvious in winter, so some patients mistakenly believe that this is exfoliative keratolysis.

Most patients apply moisturizer to relieve the pain, but this does not provide a therapeutic effect.

Figure 2 Copyright image, no permission to reprint

If things go on like this, tinea manuum will become more and more serious. Therefore, we must remember the differences between exfoliative keratolysis and scaly keratotic tinea manuum:

1. Exfoliative keratolysis is mainly manifested by the appearance of paper-thin epidermal scaling on the palms of the skin, which is painless and itchy.

The symptoms of scaly and keratotic tinea manuum include thickening and roughening of the skin, sometimes cracking and pain, in addition to scales. The cracks are deeper and the pain is more severe in winter.

2. Exfoliative keratolysis is mostly symmetrically distributed on both hands, while scaly and keratotic tinea manuum usually appears on one hand.

3. Scaly and keratotic tinea manuum is a fungal infection, and the dandruff fungal test is positive.

If you have the above symptoms of scaly and keratotic tinea manuum, you must seek medical attention in time. Most patients will recover quickly after treatment. As long as you cooperate with the doctor's treatment plan, I believe you will soon have a pair of beautiful hands!

References

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). Chinese Journal of Mycology, 2022, 17(2): 89-93.