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Ringworm on Hands and Fingers: Tinea Manuum

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Ringworm is a common fungal infection that can affect various parts of the body. Depending on the part involved, it can have various names. 

If it involves the foot, it is called athlete’s foot or tinea pedis. When ringworm involves hands and fingers, it is called tinea manuum. 

Mild cases of ringworm of the hands may be treated with over-the-counter antifungals. It can be mistaken for other skin conditions that affect hands, so it should be differentiated from such conditions.

Ringworm on hands.

How common is ringworm on hands?

Tinea manuum by itself is not very common and when it occurs, it usually involves one hand. It frequently occurs along with tinea pedis or ringworm of the foot.

When ringworm of one hand coexists with tinea pedis or ringworm of both feet, it is known as “two feet-one hand syndrome”. 

As per one study on the distribution of cases of tinea manuum, the following findings were seen:

  • Involvement of both feet and one hand in 65% of cases.
  • Involvement of both feet and hands in 19% of cases.
  • Involvement of one hand in 12% of cases.
  • Involvement of both hands in 4% of cases.

So, you can see, ringworm by hand itself is not common. If you have ringworm on your hands, always check your feet for any infected areas.

Pictures and symptoms

When the fungus infects the skin, it takes some time to show symptoms. For skin, it usually takes 4-10 days for symptoms to appear. 

It can involve the area between the finger, palmar surface of hands, and back of the hands. 

On the palms, it usually presents with thickening of skin, itching, redness, dryness, and cracking of skin. You may notice white scales in the furrows.

On the back of the hands, it usually presents with a ring-shaped circular rash with elevated edges and clearing in the center. These patches are usually pink or red in people with lighter skin tones and brown or gray in people with darker skin tones.

Ringworm on hand.

On the skin between the fingers, it may lead to red, dry, and scaly patches. You may notice red bumps or fluid-filled bumps called blisters. 

Ringworm on finger.

Ringworm may spread and involve nails; this is called tinea unguium. 

Causes

Ringworm is caused by a group of fungi called dermatophytes. It includes:

  • Trichophyton
  • Microsporum
  • Epidermophyton

Tinea manuum is most commonly caused by the fungus Trichophyton rubrum.

These fungi can survive and grow in warm and moist environments. These can be often found in swimming pools, public showers, gym locker rooms, etc. These can also survive for a long time on contaminated surfaces (around 1-2 years).

One can get it:

  • By touching any other part of the body with ringworm rash.
  • By coming in contact with someone else with ringworm rash.
  • Contact with infected animals or pets like dogs, cats, and cattle.
  • Contact with contaminated surfaces like clothing, combs, shoes, etc.
  • Contact with contaminated soil. 

Certain factors may put one at increased risk of ringworm. These include:

  • Excessive sweating.
  • Living in a hot and humid environment.
  • Contact sports like wrestling.
  • Sharing personal items with others like bedding, towels, clothes, etc.
  • Pet owners or working with animals like on farms.
  • Trauma or injury to hands. 
  • Exposure to chemicals at work may make hands more prone to get infections.
  • Being overweight.
  • Underlying medical conditions like diabetes, hypertension, and atherosclerosis.
  • Immunosuppressed immune system.

Since this infection is very contagious, one can spread it to others easily.

Look-alikes

Some skin conditions which affect hands can be mistaken for ringworm. The following are the common ones:

1. Psoriasis

It is usually bilateral and also involves other parts of the body, particularly the extensor aspect of the knees and elbows, and scalp. It may be associated with itching. One may also see changes on nails like pitting and oil stains.

In addition, one may have a family history of psoriasis. This is a chronic skin condition and cannot be cured, unlike ringworm which can be cleared by antifungals.

2. Contact dermatitis 

One can develop contact dermatitis after coming in contact with an allergen or irritant. It can lead to red, dry, and scaly patches. These are usually associated with itching.

Often the person may remember the lesion appearing after contact with something like poison ivy or cleaning supplies. 

3. Dyshidrotic eczema

This type of eczema involves palms and soles resulting in itchy blisters, especially on the sides of fingers and toes. Once the blisters heal, they can lead to red and dry skin. 

Often, dyshidrotic eczema will involve both hands. It is often associated with stress, excessive sweating, or allergies. Some people with this eczema will have a family history.

Read the full article on dyshidrotic eczema.

4. Granuloma annulare (localized type)  

This usually involves the back of the hands, feet, wrist, and ankles leading to non-itchy round circular patches. The surface of these patches is smooth, unlike ringworm which has a scaly surface. It is frequently seen in young adults and the exact cause is not clear. 

In addition, all the above-mentioned conditions are not contagious and will not improve with topical antifungals whereas ringworm rash will clear.

Diagnosis

Your doctor may diagnose your skin condition based on the appearance of the rash. In some cases, they may do additional tests to confirm and rule out other skin conditions. These may include:

1. KOH (Potassium hydroxide) preparation

For this test, your doctor will take skin scrapings from the edge of the lesions. They will put it on a slide and add 1-2 drops of 10-20% KOH. Sometimes, they will heat the slide for better examination. This slide is examined under a microscope to look for fungus.

2. Fungal culture

In some cases, your doctor may send the sample to a lab. The sample is added to a growth media which allows the fungi to grow. This is then identified by a specialist. This usually takes a lot longer to give results.

3. Dermoscopy

Your doctor may use an instrument called a dermoscope to examine the lesions on the skin. In tinea manuum, they will often see white scales localized to the skin furrows. 

4. Skin biopsy

Very rarely, your doctor may do a skin biopsy to rule out other skin conditions. Here a skin sample is taken, processed, stained, and looked under the microscope by a Pathologist.

Treatment

Your doctor may recommend treating mild cases of ringworm on hand with over-the-counter topical antifungals. These can be in the form of cream, ointment, spray, or powder. 

They usually contain the following antifungals:

  • Clotrimazole (Lotrimin)
  • Terbinafine (Lamisil)
  • Miconazole
  • Ketoconazole

Follow the instructions on the packaging or guidelines given by your treating doctor.

One may need to use these medications twice daily for 2-6 weeks. Clean and dry the area before applying medication and extend it 1-2 cm beyond the border of the rash. 

If your rash does not improve, see your doctor. They may prescribe stronger antifungals or oral antifungal medications.

Oral antifungals may also be needed in:

  • Severe cases.
  • Involvement of fingernails along with hands.
  • If ringworm involves multiple parts of the body. 
  • If you are immunosuppressed.

The oral antifungals include:

  • Griseofulvin
  • Terbinafine
  • Itraconazole
  • Fluconazole

Once you start the treatment, your rash may improve quickly. However, make sure to finish the full course of treatment. Stopping the treatment too early may make your ringworm rash come back. 

In addition, follow these measures to prevent the spread of infection:

  • Take a bath every day and dry your body before putting on clothes.
  • Keep a separate towel for the infected area and wash it after every use.
  • Change clothes and bedding every day.
  • Wash your clothes and bedding with detergent and hot water.
  • Wash your hands after treating any area with ringworm.
  • Do not share your personal things with anyone else.
  • Do not use steroids for ringworm. They may decrease redness and itching but they can make the underlying fungal infection worse.
  • Treat all the areas with ringworm – if you have ringworm on your hand and foot, treat them together otherwise you can end in a never-ending cycle of reinfection. 

Prevention

The following measures may be helpful in preventing future ringworm infections of the hand.

  • Keep your hands clean and dry.
  • Keep your fingernails clean and trimmed.
  • If you have ringworm in any area, avoid touching it and treat it so that it doesn’t spread to your hands.
  • Wear shoes or slippers in public or shared areas.
  • Don’t share personal items with others.
  • Wear breathable clothes and shoes.
  • Take a bath daily and change clothes.
  • Wipe the surfaces in shared areas like gym equipment or sports gear.
  • Take a bath after excessive sweating or any session of contact sports.
  • Wash your hands after touching, grooming, or playing with pets or animals. If your pet has a suspicious scaly patch, get them examined and treated by a Veterinary doctor.

Further reading

References

Disclaimer: This blog post is for information purposes only and does not replace medical advice.

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