For about 4 months, a very dry, diffuse,
fine scaly, asymptomatic eruption
covered the palms of a 28-yearold
man; several fingernails were
dystrophic bilaterally as well. Before
the onset of this condition, bilateral
onychomycosis of the toenails had
been diagnosed. The toenails had not
been treated and were still affected
at the time of presentation. Branching
hyphae were seen on a potassium
hydroxide preparation of a fingernail
cutting. The patient had tinea manuum
and tinea unguium.
The presentation of tinea manuum
is similar to that of tinea corporis.
Both conditions typically arise as a
flat, scaly lesion that eventually manifests
a raised, rounded border. The
border gradually enlarges, with clearing
of the center, and may develop red papules or vesicles.
Central areas become brown or hypopigmented and may
have large papules. The lesion can be as small as a centimeter
in diameter or cover large areas. Manifestations of
tinea of the palm are similar to those of tinea of the sole;
a dry, keratotic appearance may result from heavy manual
Often, tinea manuum and tinea pedis coexist. In such
cases, usually 1 foot and 2 hands or 2 feet and 1 hand are
A 3-month course of oral terbinafine eradicated this
patient's hand and nail infections.