A Dermatologic Vignette

Pictured below are the hands of a 35 year-old plumber I saw yesterday. He was not aware of a dermatitis of his feet, but inspection showed mild moccasin-type Tinea pedis on both feet and subtle onychomycosis. KOH prep from the right hand was positive for septate hyaline hyphae.

Dermatologists see two foot and one hand disease regularly. Why this affects both feet and often toe nails and only one hand is a mystery.

This man had been treated with various creams for "hand dermatitis" without relief. Knowing of the entity "Two Hand and One Foot Disease" will enable you to quickly make the right diagnosis. The question of why this occurs is still unanswered.

I prescribed ultramicrosized griseofulvin (Gris-Peg) 375 mg per day. We'll see how it works. I prefer griseofulvin to terbinafine (Lamisil) because I do not trust Novartis (the company that makes the latter). They marked Lamisil too aggressively.



Right Hand


Left Hand