Monday, May 26, 2008

Two Foot and One Hand Disease

These are the hands of a 35 year-old plumber I saw recently. He was not aware of a dermatitis of his feet, but inspection showed mild moccasin-type T. pedis on both feet and subtle onychomycosis. KOH prep from the right hand was positive for septate hyaline hyphae. We all see two foot and one hand disease regularly. Do you have any theories as to why only one hand is involved? This is a peculiar dermatologic vignette.

Right Hand

Left Hand


  1. Perhaps it affects the dominant hand, which has been scratching the feet.

  2. James C. Shaw, MD, FRCPCMay 27, 2008

    I favor the concept of immunological isolation. The fungus is ubiquitous, so contact exposure seems difficult to accept. T. rubrum occurs in suseptible individuals and families, and two-foot, one hand almost always is T. rubrum, if I recall correctly.
    However, proving the theory of immunological isolation, i.e. immunologic suseptibility to infection on the right, and not on the left, would be difficult to prove (although good for a young researcher's career).
    Oral Lamisil should be effective, but I suspect that has already been tried.
    Best of luck.
    James C. Shaw, MD, FRCPC

  3. In my opinion invilvement of only right hand is due to scathing of both foot by the domunent hand.

  4. AnonymousJune 07, 2008

    If it is the dominent hand causing the problem then what about the case in which there is involvement of left hand while patient has right hand dominence.

  5. YES!!! I'm not alone. I figured this was a fungus based on the characteristics I've observed over the past 18 years. It started on my middle finger in 11th grade and now my right hand looks just like the photos above.

    Any thoughts as to why these little fungal beasties stop on the palms and soles of the feet and don't move around to the tops, not that I'm not grateful it's not going up my arm. I assumed moisture had to do with the feet, bottoms and between the toes would naturally seem like a more moise area, but my palms... they're not even sweaty?

  6. Mine involved primarily the back of my left hand with minimal involment of the front. I am right handed but use my left hand to hold my toenails when trimming them. It is responding to generic Lamasil. A small biopsy did not show any fungi but was "consistent with a fungal granulomatous reaction".

  7. I believe I have suffered this condition for years. My right had sloughs off skin about every 2 to 3 months and looks exactly like the photos--my left never so much as sheds a flake..of course, both my feet, 'tween the toes, have terrible outbreaks of what I always assumed was athelete's foot. How do I get rid of OHTF?

  8. AnonymousMay 17, 2010

    Nice post about Two Foot and One Hand Disease, in these days foot fungus are more common and people have to try to be careful with their health for example I spend much money in buying generic viagra only because I need it.

  9. I just got dx with One Hand Two Feet disease today. I was given a Kenolog shot and some cream to apply. My rash is on my left hand and I am right handed. I do have a few dark toe nails and my feet are always peeling. I haven't started the tx yet but will let let yall know the results and what the name of the cream is.

  10. Dear colleagues
    Dominant hand two feet is extremely common. It is often associated with Onychomycosis. One should actively look for such evidence. It should be adequately treated.
    Dr Manish Pahwa
    Max hospitals
    New Delhi, India

  11. I have it on both feet and both hands

  12. could this have anything to do with my military servicein viet nam ?

    3-12 13


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