Clinical profile of Tinea pseudoimbricata: an observational study from a tertiary care institution in western Maharashtra, India
Keywords:Tinea pseudoimbricata, Topical steroid abuse, Concentric rings
Background: Topical steroid-modified tinea corporis and tinea cruris is on the rise due to the ease of availability of over-the-counter potent topical corticosteroid preparations and their inappropriate use, alters the true morphology of lesion. As there is paucity of literature about increasing prevalence and varied presentation of this condition, we aimed to study the clinical profile and dermoscopic features of Tinea pseudoimbricata due to topical steroid abuse. We present a case-series of 77 cases of a distinct morphological pattern with central erythematous, scaly, pruritic concentrically spreading plaques with raised and scaly borders known as Tinea pseudoimbricata.
Methods: We evaluated 77 clinically diagnosed patients of Tinea pseudoimbricata with positive 10% potassium hydroxide examination and culture. Dermoscopy was performed in all patients. The demographic, clinical, and mycological features of each patient were recorded on a predesigned proforma.
Results: There were 52 male and 25 female patients with a mean age of 28.66 and a mean disease duration of 7.6 months. There was a history of application of potent or super-potent topical steroid for varying durations. Culture isolates were Trichophyton rubrum species. Dermoscopic analysis showed features of steroid abuse.
Conclusions: Injudicious and inappropriate use of topical steroid causes Tinea pseudoimbricata; a special subset of tinea incognito, which is very common now a days. This should alert the dermatologist about the steroid abuse and requires systemic anti-fungal treatment for prolong time.
Sonthalia S, Singal A, Das S. Tinea cruris and tinea corporis masquerading as tinea indecisiva: Case report and review of the literature. J Cutan Med Surg. 2014;18:1-6.
Batta K, Ramlogan D, Smith AG, Garrido MC, Moss C. ‘Tinea indecisiva’ may mimic the concentric rings of tinea imbricata. Br J Dermatol. 2002;147:384.
Lim SP, Smith AG. “Tinea pseudoimbricata”: Tinea corporis in a renaltransplant recipient mimicking the concentric rings of Tinea imbricata. Clin Exp Dermatol. 2003;28:332-3.
Singal A, Jakhar D, Kaur I, Pandhi D, Das S. Tinea pseudoimbricata as a unique manifestation of steroid abuse: A clinico-mycological and dermoscopic study from a tertiary care hospital. Indian Dermatol Online J 2019;10:422-5.
Verma S, Hay RJ. Topical steroid-induced Tinea pseudoimbricata: A strikingform of tinea incognito. Int J Dermatol. 2015;54:192-3.
Verma SB, Zouboulis C. Indian irrational skin creams and steroid-modified dermatophytosis-an unholy nexus and alarming situation. J Eur Acad Dermatol Venereol. 2018;32:426-7.
Jakhar D, Kaur I. Dermoscopy of topical steroid damaged/dependent face. Indian Dermatol Online J. 2018;9:286-7.
Kakkar S, Sharma PK. Topical steroid-dependent face: Response to xylometazoline topical. Indian J Drugs Dermatol. 2017;3:87-9.