Two feet-one hand syndrome

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Two feet-one hand syndrome
Specialty Dermatology, infectious diseases
Symptoms Diffuse scaling of palms and prominent palmar creases in one hand, tinea pedis in both feet [1]
Complications Secondary bacterial infection [2]
DurationTendency to last longterm [3]
Causes Trichophyton rubrum [3]
Risk factors Excessive sweating [4]
Diagnostic method Visualization, microscopy, culture [4]
Differential diagnosis Dermatitis, psoriasis, keratoderma, hyperkeratosis, allergic contact dermatitis [5]
PreventionFoot hygiene, [4] avoid scratching feet and toes [6]
Treatment Antifungals [4]
Medication Oral terbinafine, itraconazole, fluconazole, griseofulvin [4]
FrequencyMales>females [3]

Two feet-one hand syndrome(TFOHS), is a long-term fungal condition where athlete's foot or fungal toe nail infections in both feet is associated with tinea manuum in one hand. [3] [7] Often the feet are affected for several years before symptoms of a diffuse scaling rash on the palm of one hand appear, which is when most affected people then seek medical help. [7]

Contents

The most common causative organism is Trichophyton rubrum . [3] The condition is more likely to occur in people who sweat more. [4] Diagnosis is by visualization, microscopy and culture. [4] It may appear similar to dermatitis, psoriasis, keratoderma, hyperkeratosis and allergic contact dermatitis. [5] Treatment is with long-term systemic antifungals, typically oral terbinafine or itraconazole. [4] [8]

The condition is frequently seen in skin clinics. [9] Males are affected more frequently than females. [3] One study showed that 65% of cases with tinea manuum were part of TFOHS. [6] [10] TFOHS was first described by Curtis in 1964. [11]

Signs and symptoms

TFOHS is a long-term fungal condition where athlete's foot or fungal toe nail infections in both feet is associated with tinea manuum in one hand. [3] [7] It typically presents with a diffuse scaling rash on the palm of one hand, which is preceded, sometimes by several years, by fungal infection in both feet. [3] Palmar creases appear prominent. [1] There is typically a sharp demarcation at the wrist. [12] Signs in a hand therefore require an examination of feet. [13]

Cause

TFOHS may follow scratching feet infected by fungi or occur after a pedicure. [3] The most common causative organism is Trichophyton rubrum . [3] [2] Typically, the hand that is used to scratch the infected feet or toes is the one that contracts tinea manuum. [14] Why the other hand is spared is not clear. [15] [16] In a case-control study that also looked at scratching habits, despite concluding that it was likely that tinea manuum develops in the hand that scratches the feet, some cases of TFOHS occurred in the hand that did not scratch the feet. [9]

Risk factors are the same as for athlete's foot and include excessive sweating and weakened immune system. [4] [6] Reinfection from contaminated socks may be possible. [4]

Diagnosis

Diagnosis of TFOHS is by visualisation, microscopy and culture from skin scrapings of the edge of the rash. [2] [11] The condition may appear similar to dermatitis, psoriasis, keratoderma, hyperkeratosis and allergic contact dermatitis. [5] It is sometimes misdiagnosed as hand eczema. [17]

Treatment

Treatment is with long-term systemic antifungals, typically oral terbinafine or itraconazole. [4] [8] Other options include fluconazole and griseofulvin. [4] Prevention is focused on hygiene measures such as keeping feet dry and applying antiseptic powder. [4] Using intermittent antifungal treatment in susceptible people, and avoiding scratching the feet or picking at fungal toenail infections are further preventative measures. [6] Avoiding washing socks in cold water may help, as well as dusting feet with Tolnaftate powder. [4] Dusting socks with talc, cornstarch or rice powder may help keep feet dry. [4]

Epidemiology

It is not known how many people have TFOHS. [6] Males are affected more frequently than females. [3] Athlete's foot is the most common fungal disease, with possibly more than 50% of the population affected at some time. [2] [4] Tinea manuum accounts for less than 2% of all superficial fungal infections. [2] Tinea manuum is rare in both hands. [2] Scenarios with one foot and two hands, and one foot and one hand, have been described. [15] One study showed that 65% of cases with tinea manuum were part of TFOHS. [6]

History

The condition was first described by Curtis in 1964. [11] It was later designated a syndrome. [11]

Related Research Articles

<span class="mw-page-title-main">Tinea cruris</span> Medical condition

Tinea cruris, also known as jock itch, is a common type of contagious, superficial fungal infection of the groin and buttocks region, which occurs predominantly but not exclusively in men and in hot-humid climates.

<span class="mw-page-title-main">Tinea versicolor</span> Skin disease

Tinea versicolor is a condition characterized by a skin eruption on the trunk and proximal extremities. The majority of tinea versicolor is caused by the fungus Malassezia globosa, although Malassezia furfur is responsible for a small number of cases. These yeasts are normally found on the human skin and become troublesome only under certain circumstances, such as a warm and humid environment, although the exact conditions that cause initiation of the disease process are poorly understood.

<span class="mw-page-title-main">Athlete's foot</span> Skin infection caused by fungus

Athlete's foot, known medically as tinea pedis, is a common skin infection of the feet caused by a fungus. Signs and symptoms often include itching, scaling, cracking and redness. In rare cases the skin may blister. Athlete's foot fungus may infect any part of the foot, but most often grows between the toes. The next most common area is the bottom of the foot. The same fungus may also affect the nails or the hands. It is a member of the group of diseases known as tinea.

Dermatophyte is a common label for a group of fungus of Arthrodermataceae that commonly causes skin disease in animals and humans. Traditionally, these anamorphic mold genera are: Microsporum, Epidermophyton and Trichophyton. There are about 40 species in these three genera. Species capable of reproducing sexually belong in the teleomorphic genus Arthroderma, of the Ascomycota. As of 2019 a total of nine genera are identified and new phylogenetic taxonomy has been proposed.

<span class="mw-page-title-main">Tinea corporis</span> Medical condition

Tinea corporis is a fungal infection of the body, similar to other forms of tinea. Specifically, it is a type of dermatophytosis that appears on the arms and legs, especially on glabrous skin; however, it may occur on any superficial part of the body.

<span class="mw-page-title-main">Tinea capitis</span> Cutaneous fungal infection of the scalp

Tinea capitis is a cutaneous fungal infection (dermatophytosis) of the scalp. The disease is primarily caused by dermatophytes in the genera Trichophyton and Microsporum that invade the hair shaft. The clinical presentation is typically single or multiple patches of hair loss, sometimes with a 'black dot' pattern, that may be accompanied by inflammation, scaling, pustules, and itching. Uncommon in adults, tinea capitis is predominantly seen in pre-pubertal children, more often boys than girls.

<span class="mw-page-title-main">Tinea barbae</span> Medical condition

Tinea barbae is a fungal infection of the hair. Tinea barbae is due to a dermatophytic infection around the bearded area of men. Generally, the infection occurs as a follicular inflammation, or as a cutaneous granulomatous lesion, i.e. a chronic inflammatory reaction. It is one of the causes of folliculitis. It is most common among agricultural workers, as the transmission is more common from animal-to-human than human-to-human. The most common causes are Trichophyton mentagrophytes and T. verrucosum.

<span class="mw-page-title-main">Fungal infection</span> Disease caused by fungi to animals or humans

Fungal infection, also known as mycosis, is a disease caused by fungi. Different types are traditionally divided according to the part of the body affected; superficial, subcutaneous, and systemic. Superficial fungal infections include common tinea of the skin, such as tinea of the body, groin, hands, feet and beard, and yeast infections such as pityriasis versicolor. Subcutaneous types include eumycetoma and chromoblastomycosis, which generally affect tissues in and beneath the skin. Systemic fungal infections are more serious and include cryptococcosis, histoplasmosis, pneumocystis pneumonia, aspergillosis and mucormycosis. Signs and symptoms range widely. There is usually a rash with superficial infection. Fungal infection within the skin or under the skin may present with a lump and skin changes. Pneumonia-like symptoms or meningitis may occur with a deeper or systemic infection.

<span class="mw-page-title-main">Ciclopirox</span> Antifungal medication

Ciclopirox is a synthetic antifungal agent for topical dermatologic treatment of superficial mycoses. It is most useful against tinea versicolor. It is sold under many brand names worldwide.

<span class="mw-page-title-main">Dermatophytosis</span> Fungal infection of the skin

Dermatophytosis, also known as ringworm, is a fungal infection of the skin. Typically it results in a red, itchy, scaly, circular rash. Hair loss may occur in the area affected. Symptoms begin four to fourteen days after exposure. Multiple areas can be affected at a given time.

<span class="mw-page-title-main">Onychomycosis</span> Medical condition

Onychomycosis, also known as tinea unguium, is a fungal infection of the nail. Symptoms may include white or yellow nail discoloration, thickening of the nail, and separation of the nail from the nail bed. Toenails or fingernails may be affected, but it is more common for toenails. Complications may include cellulitis of the lower leg. A number of different types of fungus can cause onychomycosis, including dermatophytes and Fusarium. Risk factors include athlete's foot, other nail diseases, exposure to someone with the condition, peripheral vascular disease, and poor immune function. The diagnosis is generally suspected based on the appearance and confirmed by laboratory testing.

Hailey–Hailey disease, or familial benign chronic pemphigus or familial benign pemphigus, was originally described by the Hailey brothers in 1939. It is a genetic disorder that causes blisters to form on the skin.

<span class="mw-page-title-main">Tinea manuum</span> Medical condition

Tinea manuum is a fungal infection of the hand, mostly a type of dermatophytosis, often part of two feet-one hand syndrome. There is diffuse scaling on the palms or back of usually one hand and the palmer creases appear more prominent. When both hands are affected, the rash looks different on each hand, with palmer creases appearing whitish if the infection has been present for a long time. It can be itchy and look slightly raised. Nails may also be affected.

<span class="mw-page-title-main">Tinea nigra</span> Medical condition

Tinea nigra, also known as superficial phaeohyphomycosis and Tinea nigra palmaris et plantaris, is a superficial fungal infection, a type of phaeohyphomycosis rather than a tinea, that causes usually a single 1–5 cm dark brown-black, non-scaly, flat, painless patch on the palms of the hands and the soles of the feet of healthy people. There may be multiple spots. The macules occasionally extend to the fingers, toes, and nails, and may be reported on the chest, neck, or genital area. Tinea nigra infections can present with multiple macules that can be mottled or velvety in appearance, and may be oval or irregular in shape. The macules can be anywhere from a few mm to several cm in size.

<span class="mw-page-title-main">Tinea faciei</span> Medical condition

Tinea faciei is a fungal infection of the skin of the face. It generally appears as a photosensitive painless red rash with small bumps and a raised edge appearing to grow outwards, usually over eyebrows or one side of the face. It may feel wet or have some crusting, and overlying hairs may fall out easily. There may be a mild itch.

Id reactions are types of acute dermatitis developing after days or weeks at skin locations distant from the initial inflammatory or infectious site. They can be localised or generalised. This is also known as an 'autoeczematous response' and there must be an identifiable initial inflammatory or infectious skin problem which leads to the generalised eczema. Often intensely itchy, the red papules and pustules can also be associated with blisters and scales and are always remote from the primary lesion. It is most commonly a blistering rash with itchy vesicles on the sides of fingers and feet as a reaction to fungal infection on the feet, athlete's foot. Stasis dermatitis, allergic contact dermatitis, acute irritant contact eczema and infective dermatitis have been documented as possible triggers, but the exact cause and mechanism is not fully understood. Several other types of id reactions exist including erythema nodosum, erythema multiforme, Sweet's syndrome and urticaria.

<i>Trichophyton verrucosum</i> Species of fungus

Trichophyton verrucosum, commonly known as the cattle ringworm fungus, is a dermatophyte largely responsible for fungal skin disease in cattle, but is also a common cause of ringworm in donkeys, dogs, goat, sheep, and horses. It has a worldwide distribution, however human infection is more common in rural areas where contact with animals is more frequent, and can cause severe inflammation of the afflicted region. Trichophyton verrucosum was first described by Emile Bodin in 1902.

<i>Epidermophyton floccosum</i> Species of fungus

Epidermophyton floccosum is a filamentous fungus that causes skin and nail infections in humans. This anthropophilic dermatophyte can lead to diseases such as tinea pedis, tinea cruris, tinea corporis and onychomycosis. Diagnostic approaches of the fungal infection include physical examination, culture testing, and molecular detection. Topical antifungal treatment, such as the use of terbinafine, itraconazole, voriconazole, and ketoconazole, is often effective.

Topical antifungaldrugs are used to treat fungal infections on the skin, scalp, nails, vagina or inside the mouth. These medications come as creams, gels, lotions, ointments, powders, shampoos, tinctures and sprays. Most antifungal drugs induce fungal cell death by destroying the cell wall of the fungus. These drugs inhibit the production of ergosterol, which is a fundamental component of the fungal cell membrane and wall.

References

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  2. 1 2 3 4 5 6 Schachtel, April; DeNiro, Katherine L. (2021). "22. Superficial dermatophyte infections of the skin". In Jong, Elaine C.; Stevens, Dennis L. (eds.). Netter's Infectious Diseases (Second ed.). Philadelphia: Elsevier. pp. 101–102. ISBN   978-0-323-71159-3.
  3. 1 2 3 4 5 6 7 8 9 10 11 Ginter-Hanselmayer, Gabriele; Nenoff, Pietro (2018). "10. Clinically Relevant Mycoses Dermatomycoses". In Presterl, Elisabeth (ed.). Clinically Relevant Mycoses: A Practical Approach. Springer. p. 154. ISBN   978-3-319-92299-7.
  4. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 James, William D.; Elston, Dirk; Treat, James R.; Rosenbach, Misha A.; Neuhaus, Isaac (2020). "15. Diseases resulting from fungi and yeasts". Andrews' Diseases of the Skin: Clinical Dermatology (13th ed.). Elsevier. pp. 297–299. ISBN   978-0-323-54753-6.
  5. 1 2 3 Russell, James D.; McCall, Calvin O. (2015). "17. Infections in the kidney transplant recipient". In Nunley, Julia R.; Lerma, Edgar V. (eds.). Dermatological Manifestations of Kidney Disease. New York: Springer. p. 175. ISBN   978-1-4939-2394-6.
  6. 1 2 3 4 5 6 Chamorro, Monica J.; House, Steven A. (10 August 2020). "Tinea Manuum". StatPearls. StatPearls Publishing. PMID   32644474.
  7. 1 2 3 Rubin, Adam I.; Jellinek, Nathaniel J.; III, C. Ralph Daniel; Scher, Richard K. (2018). "9. Onychomycosis". Scher and Daniel's Nails: Diagnosis, Surgery, Therapy. Springer. p. 157. ISBN   978-3-319-65649-6.
  8. 1 2 Habif, Thomas P. (2016). "13. Superficial fungal infections". Clinical Dermatology (Sixth ed.). Elsevier. p. 492. ISBN   978-0-323-26183-8.
  9. 1 2 Acton, Ashton (2011). Advances in Tinea Research and Treatment: 2011 Edition: ScholarlyPaper. ScholarlyEditions. p. 3. ISBN   978-1-4649-5597-6.
  10. ↑ Zhan, Ping; Geng, Chengfang; Li, Zhihua; Jiang, Qing; Jin, Yun; Li, Caixia; Liu, Weida (August 2013). "The epidemiology of tinea manuum in Nanchang area, South China". Mycopathologia. 176 (1–2): 83–88. doi:10.1007/s11046-013-9673-9. ISSN   1573-0832. PMID   23765324. S2CID   14112962.
  11. 1 2 3 4 Bjekić, Milan (1 September 2015). "Two Feet-One Hand Syndrome: A Case Report / Sindrom dva stopala i jedne šake – prikaz slučaja". Acta Facultatis Medicae Naissensis. 32 (3): 215–219. doi: 10.1515/afmnai-2015-0022 .
  12. ↑ Marks (Jr.), James G.; Miller (Dermatologist), Jeffrey J. (2013). Lookingbill and Marks' Principles of Dermatology. Elsevier Health Sciences. p. 114. ISBN   978-1-4557-5014-6.
  13. ↑ Goodheart, Herbert P. (2010). Goodheart's Same-site Differential Diagnosis: A Rapid Method of Diagnosing and Treating Common Skin Disorders. Lippincott Williams & Wilkins. p. 187. ISBN   978-1-60547-746-6.
  14. ↑ Richardson, Malcolm D.; Warnock, David W. (2012). Fungal Infection: Diagnosis and Management. John Wiley & Sons. p. 111. ISBN   978-1-4051-7056-7.
  15. 1 2 Bikowski, Joseph (February 2014). "Update on Management of Dermatophytoses". Practical Dermatology: 23-26.
  16. ↑ Elston, Dirk (2009). "2. Fungal infections". Infectious Diseases of the Skin. Boca Raton: Manson publishing. p. 44. ISBN   978-1-84076-514-4.
  17. ↑ Lachapelle, Jean-Marie; Tennsdedt, Dominique (2014). "5. Other dermatoses affecting the hand: differential diagnosis". In Alikhan, Ali; Lachapelle, Jean-Marie; Maibach, Howard I. (eds.). Textbook of Hand Eczema. Springer. pp. 66–67. ISBN   978-3-642-39545-1.
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