34F trying to figure out if this looks more like hand eczema/dry skin or possible tinea manuum (fungal infection of the hand). I know nobody can diagnose from photos alone, but I’d appreciate opinions on the differential and whether it seems worth trying OTC antifungal treatment vs focusing on barrier repair/moisturizing.
History:
• Started initially on my dominant hand (right hand), mainly the side of the index finger
• Now involves both index fingers and a small area of the left palm
• Also a little on the thumb side facing the index finger on the right hand
• Looks like tiny flaky circles/superficial peeling
• No pain
• Minimal to no itch (although I started noticing mild itch after hyperfocusing on it)
• No cracking, oozing, blisters, or significant redness
• Lotion tends to improve the appearance temporarily
• Looks worse after washing hands and when dry
• No known new soaps/products/gloves/etc.
Important history:
• I have confirmed chronic toenail/foot fungus and was on oral terbinafine previously for a severe longstanding fungal infection (\~20 years)
• Because of that history, I’m worried about tinea manuum, but the appearance also seems very “dry skin/eczema-ish” to me
• I do have health anxiety/OCD tendencies, so I’m trying to stay objective and not catastrophize
Questions:
1. Does this visually look more consistent with irritant dermatitis/eczema or fungal infection?
2. Would a consistent OTC terbinafine cream trial be reasonable?
3. Does the distribution sound typical for tinea manuum?
4. Would you personally recommend KOH scraping/culture if this walked into clinic?
u/Inevitable_Economy_5 — 1 month ago