Two Feet - One Hand Syndrome

September 14, 2005
Raymond T. Kuwahara, MD

,
Robert Skinner, Jr., MD

A 41-year-old man presented with a 3-month history of itchy, scaly feet and right hand. The left hand was unaffected.

A 41-year-old man presented with a 3-month history of itchy, scaly feet and right hand. The left hand was unaffected.

Drs Raymond T. Kuwahara and Robert Skinner, Jr, of the University of Tennessee, Memphis, diagnosed two feet–one hand syndrome, or bilateral tinea pedis with concomitant unilateral tinea manus. This condition usually is caused by the dermatophyte Trichophyton rubrum. The diagnosis was confirmed by a potassium hydroxide preparation of scale from a lesion. Septate hyphae and spores may be seen under microscopic examination.

Generally, the patient's dominant hand becomes infected by scratching the pruritic lesions that already exist on the feet.

Topical antifungal azole creams and powders can be used to treat the condition. An oral regimen, such as a 2- to 4-week course of terbinafine or ketoconazole, may be necessary in resistant disease.

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