ConditionSkin, hair & nails
Tinea Manuum (Fungal Infection of the Hand)
Tinea manuum is a fungal infection of the skin of the hand, caused by the same dermatophyte fungi that cause athlete's foot and ringworm. It typically causes dry, scaly, thickened skin on one palm with fine white scale in the creases, or a red, ring-shaped patch on the back of the hand. A classic clue is "two feet, one hand": athlete's foot on both feet and a scaly rash on the hand you use to scratch or pick at them. It is often mistaken for eczema. Antifungal creams or tablets cure it.
Also called: Ringworm of the hand, hand fungus, fungal infection of the hand, two feet one hand syndrome
At a glance
- What it is
- A dermatophyte fungal infection of the palm or back of the hand.
- Look
- Dry, scaly palm with powdery white lines in the creases, or a red ring with a raised scaly edge on the back of the hand.
- Clue
- Usually one hand, often with athlete's foot on both feet and fungal toenails.
- Diagnosis
- Skin scraping for microscopy (KOH test) and culture.
- Treatment
- Topical antifungals for 2 to 4 weeks. Oral antifungals for palm involvement, nails or failure of creams.
- Mistakes to avoid
- Steroid creams alone can make it worse and harder to diagnose.
When to get help
See a doctor within a day or two
- A rapidly spreading red, hot, painful hand or red streaks up the arm, which suggests a bacterial infection
- Swelling and pus around the nail fold or open cracks on the hand with fever
Book a routine appointment
- A scaly or itchy rash on one hand that has not cleared with moisturizers or eczema treatment
- A ring-shaped patch on the back of the hand that is spreading
- A hand rash together with athlete's foot or thick, discolored toenails
- A hand rash in someone with diabetes or a weakened immune system
Usually safe to manage at home
- A small, typical ring-shaped patch on the back of the hand, treated with an over-the-counter antifungal cream for 2 to 4 weeks
What causes tinea manuum
Dermatophytes are fungi that live on keratin, the protein in the outer skin, hair and nails. The most common cause of tinea manuum is Trichophyton rubrum, the same fungus responsible for most athlete's foot and fungal toenail infections. Other causes include T. mentagrophytes and Microsporum canis, caught from animals.
The fungus reaches the hand by:
- Spreading from your own feet or nails: scratching or picking at athlete's foot or fungal toenails transfers fungus to the dominant hand
- Contact with infected animals: cats, dogs, guinea pigs, rabbits and cattle, usually causing an inflamed ring on the back of the hand
- Contact with soil (gardeners, farmers)
- Contact with infected people or shared items
Risk factors include sweaty hands, diabetes, a weakened immune system, and jobs that involve wet hands or gloves.
Symptoms
Tinea manuum has two main patterns:
Palm type (most common)
- Diffuse dryness, thickening and fine scaling over the palm
- Powdery white scale accentuated in the palm creases
- Mild itch or none
- Usually only one hand
- Often present for months or years and mistaken for dry skin or eczema
Back of hand type
- A red, round or oval patch with a raised, scaly, advancing border and clearer center: classic ringworm
- Itching
- Sometimes small blisters or pustules, especially with animal fungi
Fingernails on the affected hand may become thick, yellow and crumbly.
Tinea manuum vs similar rashes
| Condition | Key features |
|---|---|
| Tinea manuum | Usually one hand, fine white scale in creases, athlete's foot present, KOH test positive |
| Hand eczema or dyshidrotic eczema | Usually both hands, itchy blisters on the sides of fingers, history of eczema or allergies |
| Contact dermatitis | Linked to gloves, chemicals or frequent handwashing, often both hands, burning or itching |
| Psoriasis | Thick, well-defined plaques, often both palms, nail pitting, psoriasis elsewhere |
| Dry skin | Both hands, worse in winter, improves with moisturizer |
The "one hand, two feet" pattern is the strongest single clue to tinea.
Diagnosis
A doctor or dermatologist will examine your hands, feet and nails. The key test is a skin scraping: scale is gently scraped from the edge of the rash onto a slide.
- KOH microscopy: potassium hydroxide dissolves skin cells so fungal threads (hyphae) can be seen within minutes.
- Fungal culture or PCR: identifies the species, which helps if an animal source is suspected or treatment has failed.
Testing before treatment is important, because using a steroid cream first can change the rash's appearance (tinea incognito) and make the fungus harder to find.
Treatment
Topical antifungals
For limited infections on the back of the hand:
- Terbinafine, clotrimazole, miconazole or ketoconazole cream, applied once or twice daily
- Apply to the rash and 1 inch (2 cm) of surrounding skin
- Continue for 1 to 2 weeks after the skin looks clear, usually 2 to 4 weeks in total
Oral antifungals
The thick skin of the palm, and any nail involvement, often do not respond to creams alone. A doctor may prescribe oral terbinafine or itraconazole for several weeks. Blood tests may be needed for longer courses, and some medicines interact with these drugs.
Treat the feet too
Treating tinea manuum without treating athlete's foot or toenail infection usually leads to reinfection. Your doctor will treat all sites together.
Avoid steroid-only creams
Hydrocortisone and stronger steroid creams may briefly reduce redness but let the fungus spread. Combination steroid-antifungal creams are generally not recommended.
Prevention
- Treat athlete's foot and fungal nails promptly.
- Avoid scratching or picking at your feet, and wash hands after touching them.
- Dry hands and feet thoroughly, including between fingers and toes.
- Use separate towels for feet and the rest of the body.
- Take pets with patchy hair loss or scaly skin to a vet.
- Wear gloves for gardening and when handling animals with skin problems.
Frequently asked questions
What does fungus on the hand look like?
On the palm, it usually looks like dry, thickened, scaly skin with fine white powdery lines in the creases, often on one hand only. On the back of the hand, it forms a red, itchy, ring-shaped patch with a raised scaly edge.
What is two feet, one hand syndrome?
It is a common pattern of tinea in which both feet have athlete's foot and only one hand, usually the one used to scratch or pick at the feet, has a fungal infection. It is a strong clue that a hand rash is fungal rather than eczema.
How do you get rid of tinea manuum?
Mild patches on the back of the hand often clear with an antifungal cream such as terbinafine or clotrimazole for 2 to 4 weeks. Palm infections, nail involvement or stubborn cases usually need oral antifungal tablets. Athlete's foot must be treated at the same time.
Is tinea manuum contagious?
Yes, mildly. It can spread through direct skin contact and shared towels, and from your own feet to your hand. Animal-acquired types can spread from pets. Washing hands, not sharing towels and treating all infected sites reduce spread.
Can tinea manuum be mistaken for eczema?
Yes, very often. Both cause dry, scaly hands. Tinea manuum usually affects one hand and comes with athlete's foot, while eczema usually affects both hands. A quick skin scraping test can confirm fungus before treatment.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Dermatology: Ringworm, diagnosis and treatment
- DermNet: Tinea manuum
- CDC: About Ringworm
- MedlinePlus: Ringworm
- Merck Manual Professional Version: Tinea manuum