Encountering steroid treatment induced tinea incognito: a case report
Keywords:Tinea incognito, Anti-fungal therapy, Corticosteroids, Immunosuppressant
Tinea incognito refers to a type of dermatophyte infection that affects the skin, and its signs and symptoms upon presentation tend to appear permutated due to the prior use of immunosuppressants, corticosteroids or calcineurin inhibitors. We present a 42-year-old Asian (Indian) male patient with scaly erythematous rashes, mimicking annular erythema, and developing post-corticosteroid usage after an elective hair transplant procedure. The results of the biopsy reported that erythema annulare centrifugum (EAC) was absent, and the sample was suggestive of potential infective folliculitis. By day 3 of the presentation, with fungal stain tested positive for the presence of fungal infection. Based on this, the final diagnosis of tinea incognito was made. The final treatment prescribed for tinea incognito was an anti-fungal tablet of Itraconazole at a dose of 100 mg twice a day for 4 weeks, topical luliconazole, ciclopirox and anti-histamines for itching. Topical corticosteroids can change the clinical appearance of tinea by reducing erythema and scaling while enabling the fungus to grow freely without presenting the typical clinical indications of tinea. Practitioners should follow patients on corticosteroid treatment to alert them to potential cutaneous problems due to possible fungal infections, whenever warranted.
Ansar A, Farshchian M, Nazeri H, Ghiasian SA. Clinico-epidemiological and mycological aspects of tinea incognito in Iran: a 16-year study. Japanese J Med Mycol. 2011;52:25-32.
Kim WJ, Kim TW, Mun JH, Song M, Kim HS, Ko HC, et al. Tinea incognito in Korea and its risk factors: nine-year multicenter survey. J Korean Med Sci. 2013;28:145-51.
Atzori L, Pau M, Aste N, Aste N. Dermatophyte infections mimicking other skin diseases: a 154-person case survey of tinea atypica in the district of Cagliari (Italy). Int J Dermatol. 2012;51:410-5.
Crawford KM, Bostrom P, Russ B, Boyd J. Pimecrolimus-induced tinea incognito. Skinmed. 2004;3:352-3.
Rallis E, Koumantaki-Mathioudaki E. Pimecrolimus induced tinea incognito masquerading as intertriginous psoriasis. Mycoses. 2008;51:71-3.
Đorđević Betetto L, Žgavec B, Bergant Suhodolčan A. Psoriasis-like tinea incognita: a case report and literature review. Acta Dermatovenerol Alp Pannonica Adriat. 2020;29(1):43-5.
Zander N, Schäfer I, Radtke M, Jacobi A, Heigel H, Augustin M. Dermatological comorbidity in psoriasis: results from a large-scale cohort of employees. Arch Dermatol Res. 2017;309:349-56.
Diruggiero D. Successful Management of Psoriasis and Treatment-induced Tinea Incognito: A Case Report. J Clin Aesthet Dermatol. 2020;13(9):S21-5.
Arenas R, Moreno-Coutiño G, Vera L, Welsh O. Tinea incognito. Clin Dermatol. 2010;28(2):137-9.