P27 “Two feet‐one hand syndrome” masquerading as occupational hand eczema

Background:  Occupational hand eczema is mainly characterised by bilateral manifestation whereas one‐sided hand involvement is unusual. Subject:  We report on a 38‐year old dental technician who presented with interdigital skin alterations of the left hand resistant to previous eczematous treatment. Main professional task was the production and processing of plaster or plastic dental models. While handling with dental models like smoothing by the left hand, usually this one was splashed with plaster. On clinical examination the patient showed additionally scaly lesions on the soles. Results:  No sensitisation could be ascertained performing patch and prick tests. By normal IgE‐level, no specific antibodies against aeroallergens or occupational allergens such as isocyanates, formaldehyde or latex could be found. Mycological cultures of scaly lesions of the left hand and soles revealed an infection with Trichophyton rubrum. In accordance with the subjective perception, the starch‐iodine test showed the left hand more sweating. We diagnosed a “two feet‐one hand syndrome” and achieved healing after local antimycotical treatment. Conclusions:  In case of one‐sided, suspicious work‐related skin alterations of the hands, a “two feet‐one hand syndrome”(i.e. bilateral plantar tinea in coexistence with a unilateral tinea manuum) should be considered as differential diagnosis. A common explanation for the fungal infection of one hand is the scratching of the already infected soles. However, within occupational fields little is published about the “two feet‐one hand syndrome.” An asymmetric increased palmar sweating and a one‐sided chronic professional burden of the hands are discussed as predisposing factors for the unilateral fungal infection.