Two feet-one hand syndrome (TFOHS) is a long-term fungal condition in which

athlete's foot 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 ...

or fungal toenail infections in both feet is associated with

tinea manuum 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 palmar creases appear more prominent. When both h ...

in one hand. Often the feet are affected for several years before a diffuse scaling rash on the palm of one hand appears, at which point some affected people may decide to seek medical help. The most common causative organism is ''

Trichophyton rubrum ''Trichophyton rubrum'' is a dermatophytic fungus in the phylum Ascomycota. It is an exclusively clonal, anthropophilic saprotroph that colonizes the upper layers of dead skin, and is the most common cause of athlete's foot, fungal infection of ...

''. The condition is more likely to occur in people who sweat more. Diagnosis is by visualization,

microscopy Microscopy is the technical field of using microscopes to view subjects too small to be seen with the naked eye (objects that are not within the resolution range of the normal eye). There are three well-known branches of microscopy: optical mic ...

and

culture Culture ( ) is a concept that encompasses the social behavior, institutions, and Social norm, norms found in human societies, as well as the knowledge, beliefs, arts, laws, Social norm, customs, capabilities, Attitude (psychology), attitudes ...

. It may appear similar to

dermatitis Dermatitis is a term used for different types of skin inflammation, typically characterized by itchiness, redness and a rash. In cases of short duration, there may be small blisters, while in long-term cases the skin may become thickened ...

psoriasis Psoriasis is a long-lasting, noncontagious autoimmune disease characterized by patches of abnormal skin. These areas are red, pink, or purple, dry, itchy, and scaly. Psoriasis varies in severity from small localized patches to complete b ...

keratoderma Keratoderma is a hornlike skin condition. Classification The keratodermas are classified into the following subgroups:Freedberg, et al. (2003). ''Fitzpatrick's Dermatology in General Medicine''. (6th ed.). McGraw-Hill. . Congenital * Simple kera ...

hyperkeratosis Hyperkeratosis is thickening of the stratum corneum (the outermost layer of the epidermis, or skin), often associated with the presence of an abnormal quantity of keratin,Kumar, Vinay; Fausto, Nelso; Abbas, Abul (2004) ''Robbins & Cotran Pathol ...

and

allergic contact dermatitis Allergic contact dermatitis (ACD) is a form of contact dermatitis that is the manifestation of an allergic response caused by contact with a substance; the other type being irritant contact dermatitis (ICD). Although less common than ICD, ACD ...

. Treatment is with long-term systemic

antifungals An antifungal medication, also known as an antimycotic medication, is a pharmaceutical fungicide or fungistatic used to treat and prevent mycosis such as athlete's foot, ringworm, candidiasis (thrush), serious systemic infections such as ...

, typically oral

terbinafine Terbinafine, sold under the brand name Lamisil among others, is an antifungal medication used to treat pityriasis versicolor, onychomycosis, fungal nail infections, and ringworm including jock itch and athlete's foot. It is either oral adminis ...

itraconazole Itraconazole, sometimes abbreviated ITZ, is an antifungal medication used to treat a number of fungal infections. This includes aspergillosis, blastomycosis, coccidioidomycosis, histoplasmosis, and paracoccidioidomycosis. It may be given ...

. The condition is frequently seen in

skin Skin is the layer of usually soft, flexible outer tissue covering the body of a vertebrate animal, with three main functions: protection, regulation, and sensation. Other animal coverings, such as the arthropod exoskeleton, have different ...

clinics. Males are affected more frequently than females. One study showed that 65% of cases with tinea manuum were part of TFOHS. TFOHS was first described by Curtis in 1964.

Signs and symptoms

TFOHS is a long-term fungal condition where

or fungal toe nail infections in both feet is associated with

in one hand. 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. Palmar creases appear prominent. There is typically a sharp demarcation at the wrist. Signs in a hand therefore require an examination of feet. File:FeetFungal.JPG, Tinea of feet File:Tinea manum.jpg, Tinea manuum (one hand)

Cause

TFOHS may follow scratching feet infected by

fungi A fungus (: fungi , , , or ; or funguses) is any member of the group of eukaryotic organisms that includes microorganisms such as yeasts and mold (fungus), molds, as well as the more familiar mushrooms. These organisms are classified as one ...

or occur after a pedicure. The most common causative organism is ''

''. Typically, the hand that is used to scratch the infected feet or toes is the one that contracts tinea manuum. Why the other hand is spared is not clear. 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. Risk factors are the same as for athlete's foot and include excessive sweating and

weakened immune system Immunodeficiency, also known as immunocompromise, is a state in which the immune system's ability to fight infectious diseases and cancer is compromised or entirely absent. Most cases are acquired ("secondary") due to extrinsic factors that affec ...

. Reinfection from contaminated socks may be possible.

Diagnosis

Diagnosis of TFOHS is by visualisation,

and culture from skin scrapings of the edge of the rash. The condition may appear similar to

and

. It is sometimes misdiagnosed as

hand eczema Hand eczema presents on the palms and soles, and may sometimes be difficult or impossible to differentiate from atopic dermatitis, allergic contact dermatitis, and psoriasis, which also commonly involve the hands. Even a biopsy of all these cond ...

Treatment

Treatment is with long-term systemic

, typically oral

. Other options include

fluconazole Fluconazole is an antifungal medication used for a number of fungal infections. These include candidiasis, blastomycosis, coccidioidomycosis, cryptococcosis, histoplasmosis, dermatophytosis, and tinea versicolor. It is also used to pr ...

and

griseofulvin Griseofulvin is an antifungal medication used to treat a number of types of dermatophytoses (ringworm). This includes fungal infections of the nails and scalp, as well as the skin when antifungal creams have not worked. It is taken by mouth. ...

. Prevention is focused on

hygiene Hygiene is a set of practices performed to preserve health. According to the World Health Organization (WHO), "Hygiene refers to conditions and practices that help to maintain health and prevent the spread of diseases." Personal hygiene refer ...

measures such as keeping feet dry and applying antiseptic powder. Using intermittent antifungal treatment in susceptible people, and avoiding scratching the feet or picking at fungal toenail infections are further preventative measures. Avoiding washing socks in cold water may help, as well as dusting feet with

Tolnaftate Tolnaftate (INN), sold under the brand name TAGRID, among others, is a synthetic thiocarbamate used as an anti-fungal agent that may be sold without medical prescription in most jurisdictions. It is supplied as a cream, powder, spray, liquid, ...

powder. Dusting socks with talc, cornstarch or rice powder may help keep feet dry.

Epidemiology

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

History

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

References

{{Reflist Mycosis-related cutaneous conditions Cutaneous conditions