From the Guidelines
Tinea manuum is typically treated with antifungal medications, and the most effective treatment is terbinafine 250mg daily for 2-6 weeks, as it has a high cure rate and low relapse rate compared to other antifungal agents 1.
Treatment Options
- For mild cases, topical antifungal creams like clotrimazole 1% (Lotrimin), miconazole 2% (Micatin), or terbinafine 1% (Lamisil) can be applied to affected areas twice daily for 2-4 weeks.
- For more severe or resistant infections, oral antifungal medications like terbinafine 250mg daily for 2-6 weeks or itraconazole 200mg daily for 1-2 weeks may be necessary.
Important Considerations
- Good hygiene practices are essential during treatment, including keeping hands clean and dry, avoiding sharing towels or personal items, and wearing breathable gloves when working with water or irritants.
- Treatment should address any concurrent fungal infections elsewhere on the body, particularly the feet (tinea pedis), as these often serve as reservoirs for reinfection.
- Antifungals work by disrupting the fungal cell membrane or inhibiting ergosterol synthesis, which is essential for fungal cell growth and reproduction.
Potential Side Effects and Interactions
- Terbinafine can cause side effects like nausea and rashes in 8-15% of patients, and it is contraindicated in pregnancy and caution is advised for men fathering a child for 6 months after therapy 1.
- Itraconazole can cause enhanced toxicity of certain medications, such as anticoagulants, antihistamines, and anxiolytics, and monitoring of liver function is required for treatment durations of longer than 1 month 1.
From the Research
Treatment Options for Tinea Manuum
- Topical medications applied once or twice daily are the primary treatment indicated for tinea manuum 2
- Oral antifungals, such as itraconazole and terbinafine, may be used for extensive or chronic cases 2
- Treatment requires attention to exacerbating factors such as skin moisture and choosing an appropriate antifungal agent 3
Antifungal Agents
- Azoles and allylamines are commonly used antifungal agents for treating tinea manuum 2, 3
- Itraconazole has been shown to be effective in treating tinea pedis and tinea manuum, with two possible treatment schedules: 400 mg daily for 1 week or 100 mg daily for 4 weeks 4
- Terbinafine is also an effective treatment option for tinea manuum, with a shorter treatment duration compared to griseofulvin 5
Treatment Duration and Follow-up
- Treatment should continue for at least one week after clinical clearing of infection 3
- Appropriate follow-up duration and education of patients on proper hand hygiene are important components in providing effective therapy 2
- The presence of inflammation may necessitate the use of an agent with inherent anti-inflammatory properties or the use of a combination antifungal/steroid agent 3