Tinea Manuum

　　Tinea manuum is mainly caused by infections with Trichophyton rubrum (accounting for about 55.6%), Trichophyton mentagrophytes (calcarea-like), and Trichophyton tonsurans (about 22.7%). This disease is mainly transmitted by contact, and important predisposing factors for tinea manuum infection include long-term immersion of both hands in water, frictional injury, contact with detergents and solvents, etc., so the incidence of tinea manuum can be quite high in certain industries. Most patients are young and middle-aged women, many of whom have a history of wearing rings.

　　Severe tinea manuum can cause skin pain and discomfort. The muscles of the affected area are exposed or compressed by deformed nails, and once subjected to various injuries, bacteria can easily penetrate and cause complications such as paronychia, onychomycosis, and finger pyoderma. This may lead to serious systemic diseases such as erysipelas or cellulitis.

　　The classification of tinea manuum is the same as that of tinea pedis, but the most common types are hyperhidrotic and scaly keratotic types. The clinical manifestations are closely related to the pathogenic bacteria causing the infection.

　　Hyperhidrotic type:The initial onset is often on the palm and between the thumb and index finger, with an acute onset and mainly presents with blisters, which may be grouped or scattered in a fire jar network. The blisters are deeper with thick walls and are not easy to break. After several days, the blister fluid is absorbed and desquamated, with scales presenting in a collar shape, and the skin lesions spread and expand around. Secondary bacterial infection can lead to pustules and secondary eczematous changes with severe itching. It often occurs in summer, mainly caused by Trichophyton rubrum.

　　Scale hyperkeratosis type: It starts with papules or blisters, the onset is slower, the location of blisters is relatively shallow, and secondary bacterial infection is less common. The vesicle wall is easy to break and form desquamation, with mild itching. In patients with recurrent and prolonged course, hyperkeratosis and thickening of the skin may occur, often affecting both hands, involving the entire palm and even the back of the hand. The characteristic of skin lesions is rough and thickened skin with less sweat, marked hyperkeratosis with desquamation, and due to the rough and thickened skin, it is easy to have fissures and pain. It is common to culture Trichophyton rubrum and Trichophyton mentagrophytes.

　　Maceration erosion type: It is less common, and it is only easy to see after secondary bacterial infection of blisters, showing acute or subacute eczematous changes.

　　Tinea manuum is more common in middle-aged and elderly people, more common in men than in women, mostly unilateral, and can develop into bilateral over time. Blisters are more common in summer, and fissures are common in winter, often affecting activities due to pain. Due to the frequent stimulation of external factors such as detergents, tinea manuum is not typical and is easily overlooked, leading to delayed healing. Tinea manuum is often transmitted from tinea pedis or secondary to onychomycosis, but it can also be primary, with primary lesions mostly seen on the side of the thumb and index finger, interdigital areas, and early skin lesions on the palm, which then gradually spread.

　　Tinea manuum is common in patients with hyperkeratotic tinea pedis, mostly non-inflammatory, and unilateral (bilateral foot and hand syndrome). The palms and fingers have diffuse hyperkeratosis. There may also be desquamation, blisters, and papules.

　　1. In daily life, pay attention to personal hygiene, do not use public slippers, foot basins, and towels, and shoes, socks, and footcloths should be sterilized regularly to keep the feet clean and dry.

　　2. Shoes, socks, and footcloths should be sterilized regularly to keep the feet clean and dry. Public places such as bathrooms and swimming pools are the main places for the transmission of tinea pedis, and strict disinfection management should be implemented.

　　3. After washing your feet or taking a bath at night, dry the moisture between the toes, sprinkle disinfectant powder (menthol 0.1g, thymol iodide 2g, zinc stearate 4g, magnesium carbonate 2g, borax 15g, talc added to 100g), the purpose is to keep the toes as dry as possible to prevent re-infection of the epidermal mold.

　　4. Do not have improper sexual relations with others. Do not use others' underwear, panties, and bathing products.

　　5. In daily life, reduce the adverse stimulation of chemical, physical, and biological substances on the skin of the hands and feet. If you are a patient, avoid drinking stimulating drinks such as strong tea, coffee, and alcohol, as these drinks stimulate the secretion and excretion of sweat glands, providing a favorable environment for the susceptibility of epidermal molds.

　　6. Reduce sweating and promote the evaporation of the root of the thigh. Try to keep the perineum dry, wear loose and comfortable underwear, and do not wear it too tightly.

　　7. Change and wash your underwear frequently, and keep the external genitalia clean. Regularly wash and dry your clothes and bedding.

　　If you have onychomycosis, tinea cruris, or tinea corporis, you should actively treat them to prevent transmission to the perineum and inguinal area through hands.

　　Laboratory examination

　　Microscopic examination of fungal spores can be observed by taking scales or vesicle walls for direct microscopic examination, showing hyphae or arthrospores, with a low positive rate for keratotic examination.

　　Method: Scrape the scales, pick the vesicle fluid, add 10% KOH for microscopic examination, and visible branching septate hyphae can be seen. However, the positive rate of direct microscopic examination of hyperkeratotic thickening type tinea manuum is low, and repeated examination is needed. Take scales or vesicle fluid to inoculate on Sabouraud's agar, incubate at a constant temperature, and there will be colony growth within 2 weeks. The species can be identified according to the colony morphology and microscopic characteristics.

　　Other auxiliary examinations

　　Histopathology: In the acute stage, there is intercellular edema and spongelike formation, cell infiltration, vesicles located below the stratum corneum of the epidermis, and incomplete keratinization may be present. In the chronic stage, there is hyperkeratosis, thickening of the stratum spinosum, and chronic inflammatory infiltration. Fungal hyphae can be found in the stratum corneum by PAS staining.

　　Foods suitable for hand tinea patients

　　1. Suitable for cooling blood and detoxifying foods. Mung beans, glutinous rice, cucumbers, bitter melon, purslane, green tea, etc.

　　2. Hand tinea patients should drink more water, drink 3 liters of water per day (this must be done), and can eat rice and coarse grains, but the vegetables should be green vegetables, and there should be green vegetables in every meal, and other vegetables as auxiliary.

　　Foods not suitable for hand tinea patients

　　It is not advisable to eat acidic foods, such as oil-pumped, pickled, cola, hamburgers, milk, sugar, nuts, beans, meat and vegetables, which will worsen the condition of hand tinea.

　　For vesicular and scaly type, external application of econazole, clotrimazole cream, compound benzoic acid liniment, and compound resorcinol liniment can be used; for hyperkeratotic thickening type, compound benzoic acid ointment, econazole cream, or 10% glacial acetic acid soak can be used; for those with cracks, urea cream can be added. After the skin lesions subside, the medication should be continued for at least 2 weeks; the frequency of hand medication should be appropriately increased, especially after washing hands, add ointment or cream, for those with long course of disease or poor local treatment effect, oral griseofulvin, ketoconazole, etc. can be taken; or fluconazole 50mg/day or 150mg/week, taken in a single dose for 2-4 weeks; itraconazole 200mg/day, taken in a single dose for one week; Thiram 250mg/day, taken for 2 weeks. At the same time, Zhangling plaster can also be used to apply to the affected area, no cleaning is needed after the application, and the skin automatically absorbs.

　　The external application of Zhangling plaster is quite simple and can avoid the many disadvantages of oral medications, safe and convenient. Directly apply Zhangling powder to the affected area of tinea manuum, so that the drug can directly reach the lesion, and exert therapeutic effects on the local affected tissue, with very rapid efficacy.