The Crease Scale Sign as a Diagnostic Aid in Tinea Manuum

A 38-year-old female presented with itchy skin lesions on the right palm for the last 6 months. She had been treated with topical steroids without any improvement. Examination revealed mild hyperkeratosis of the right palm and scaling over the interdigital folds and palmar creases (Figure 1). There were no lesions on the left palm or other areas of the skin. A KOH mount was prepared from the skin scrapings, which showed septate, branching, long, narrow hyphae on light microscopy at 40× magnification (Figure 2). A diagnosis of tinea manuum was made. Oral itraconazole and topical luliconazole lotion were prescribed to the patient. Tinea manuum is a dermatophytic infection that is often unilateral and affects the palms, interdigital folds and creases. Patients usually present with palmar itch [1]. Clinical presentations of tinea manuum include diffuse palmar scales, interdigital scales, vesiculobullous lesions and annular erythematous plaques if the dorsum of the hand is involved [2]. Dermatophytes are keratophilic, and scaling over the creases can be explained by increased proliferation of keratinocytes in response to dermatophytic infection [3]. Sunil Jaiswal: conceptualisation (lead), writing – original draft (lead), writing – review and editing (lead). Shraddha Uprety: investigation (lead), writing – original draft (lead). Pratichya Thapa: conceptualisation (lead), methodology (lead). Prakriti Lamichhane: methodology (lead), conceptualisation (supporting). The patient in this manuscript has given written informed consent for participation in the study and the use of their de-identified, anonymised, aggregated data and their case details (including photographs) for publication. The authors declare no conflicts of interest. The data that support the findings of this study are available from the corresponding author upon reasonable request.