2 FEET ONE-HAND SYNDROME - A RETROSPECTIVE MULTICENTER SURVEY

Background The two feet-one hand syndrome is not uncommon; however, th ere have only been a few reports on this condition, This study was und ertaken to obtain a better understanding of the epidemiology of the tw o feet-one hand syndrome, Methods A retrospective chart review was con ducted of all the patients seen in our practices over the past 15 year s with the diagnosis of two feet-one hand syndrome. Results A total of 80 patients with mycologically confirmed disease were identified (men , 72 (90%); women, 8 (10%); 77 (96%) Caucasian; 3 (4%) African-America n; age (mean +/- standard error (SE)), 55.9 +/- 2.1 years). The mean a ge of the patients when the physician was first seen for the condition was 51.3 +/- 2.0 years. The mean ages when the symptoms first develop ed on the feet and hand were 37.1 +/- 2.4 years and 45.7 +/- 2.2 years , respectively. Tinea pedis was found to occur at an earlier age than tinea manuum (t(65)=6.92, P<0.01). There was a significant relationshi p between the hand in which tinea manuum developed, the hand used to e xcoriate the soles of feet (chi(2)(4)=14.82, P<0.01), and the hand use d to pick toenails (chi(2)(4)=14.82, P<0,01); however, there was no si gnificant relationship between handedness and the development of tinea manuum in the dominant hand. The occupation of the patient at the tim e of development of the two feet-one hand syndrome was categorized acc ording to whether the intensity of hand use was high, moderate, or low . Patients with a high intensity of hand use in their jobs were signif icantly more likely to develop tinea pedis/onychomycosis (r=-0.27, F(1 ,61)=4.77, P<0.05) and tinea manuum (r=-0.30, F(1,62)=6.31, P<0.05) at an earlier age. The best multiple predictors of the age at which medi cal attention was sought were the age of onset of tinea manuum and a f amily history of tinea infection (r=0.86, F(2,59)=86.9, P<0.01). The a ge of onset of tinea manuum was the best single predictor, with a corr elation of 0.85. Conclusions In the two feet-one hand syndrome, the de velopment of tinea pedis/onychomycosis generally preceded the developm ent of tinea manuum. Tinea manuum usually developed in the hand used t o excoriate the feet or pick toenails. Patients whose occupation invol ved a high intensity of use of the hands were more likely to develop t he disease at an earlier age, Patients were more likely to seek attent ion once tinea manuum had developed, particularly if there was a famil y history of tinea infection.