Topical steroid-induced tinea pseudoimbricata: a striking form of tinea incognito

Shyam Verma; Roderick J. Hay

doi:10.1111/ijd.12734

Medication Practice of Patients with Dermatophytosis

Journal of Nepal Medical Association ◽

10.31729/jnma.2830 ◽

2016 ◽

Vol 55 (203) ◽

pp. 07-10 ◽

Cited By ~ 1

Author(s):

Yogesh Poudyal ◽

Shambhu Dutta Joshi

Keyword(s):

Observational Study ◽

Odds Ratio ◽

Topical Steroid ◽

Tinea Corporis ◽

Self Medication ◽

Cross Sectional ◽

Clinical Pattern ◽

Medication Practice ◽

Tinea Incognito ◽

Case Collection

Introduction: Dermatophytosis is one of the commonest dermatoses observed in Dermatology OPD. It is caused by Fungus Dermatophyte. Its pattern and prevalence varies from region to region. As self medication practice is very common, we aim to find the prevalence of various clinical pattern of dermatophytosis and to find out the medication commonly used by the patients for this condition.Methods: This was cross sectional observational study. The case collection was done from outpatient department of Dermatology and Venereology of a Teaching Hospital from 15th March, 2013 to 14March, 2014. Demographic, Clinical and other relevant details were recorded in Proforma after history and examination. Results: The total number of cases were 594. Crural area was the most commonly involved. Tinea corporis was most common dermatophytosis followed by Tinea incognito. Risk of recurrence was highest in buttocks [odds ratio-2.404 (1.510, 3.827) and crural area [odds ratio- 2.298 (1.637,3.266). Topical steroid and topical steroid with antifungal was used by 225 (30.1%) and 226 (30.2%) respectively. Patients who consulted dermatologist were more likely to use antifungal, odds ratio- 12.060 (4.907, 29.643).Conclusions: Tinea corporis was the commonest dermatophytosis. Due to practice of topical steroid misuse T. incognito was second common. It is essential to educate the general public, pharmacist and paramedics regarding the proper use of topical steroid. Keywords: dermatophytosis; steroid; tinea. | PubMed

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Tinea incognito with unjustified use of potent Topical Corticosteroids: a case series

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20173301 ◽

2017 ◽

Vol 6 (8) ◽

pp. 2087

Author(s):

Haiya J. Sheth ◽

Santosh P. Rathod ◽

Raju G. Chaudhary ◽

Supriya D. Malhotra ◽

Pankaj R. Patel

Keyword(s):

Symptomatic Relief ◽

Topical Steroid ◽

Case Series ◽

Superficial Infection ◽

Steroid Abuse ◽

Inappropriate Use ◽

Monitoring Centre ◽

Topical Corticosteroids ◽

Chief Complaints ◽

Tinea Incognito

Topical corticosteroids prescribed for various dermatological conditions, if used haphazardly have their adverse effects too, like aggravation of underlying infections - tinea, herpes etc. Tinea incognito is a fungal infection of skin masked and often exacerbated by application of topical immunosuppressive or steroid agent. Tinea incognito results because local physicians/chemists might mistake tinea with a simple rash. Availability of a topical steroid cream as an over the counter (OTC) drug is also one of the causes. Once it is diagnosed (clinically with or without KOH mount preparation), it should be thoroughly treated with oral and topical antifungal agents. Four cases presenting to Dermatology OPD VSGH with chief complaints of itching and aggravation of existing lesions due to application of potent topical corticosteroids like Clobetasol and Beclomethasone have been discussed here. They were diagnosed as cases of Topical Corticosteroids induced Tinea Incognito. The patients were recovering with oral and topical antifungals prescribed by dermatologist. These were also reported to nearest ADR Monitoring Centre under PvPI with Probable causality according to WHO UMC Criteria for Causality Assessment. The wide use of topical corticosteroids is due to its immediate symptomatic relief. However, the normal presentation of superficial infection gets altered with their inappropriate use. Lack of awareness among population, steroid abuse by local physicians or no strict regulations for local chemist shops have led to its inappropriate use. Its incidence ranges from 5-15%. These figures point towards the fact that implementation of appropriate regulations for the safe use of topical corticosteroids is essential.

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A study on the clinical profile of dermatoses induced by topical corticosteroids

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20210041 ◽

2021 ◽

Vol 7 (2) ◽

pp. 177

Author(s):

Vontela Rohit ◽

S. Rajesh Reddy ◽

Narendar Gajula ◽

Karing Deepthi

Keyword(s):

Side Effects ◽

Clinical Presentation ◽

Tertiary Care ◽

Topical Steroid ◽

Age Group ◽

Over The Counter ◽

Study Region ◽

Topical Corticosteroids ◽

Wide Range ◽

Tinea Incognito

Background: Topical corticosteroids (TC), commonly used for a wide range of skin disorders, are associated with many side effects with their overuse, abuse and over-the-counter use as a cosmetic. This article aims to study clinical presentation of various dermatoses induced by abuse of TC in order to bring awareness among patients and practitioners to use topical corticosteroids with utmost caution.Methods: This study was conducted at DVL department of a tertiary care teaching hospital over 23 consecutive months. A total of 200 consecutive patients of all ages and both genders with topical steroid induced dermatoses were included in the study. A detailed clinical evaluation was undertaken, data was then recorded and analysed.Results: Majority of the patients were females (56%). Most common age group was 20-29 years (42%). Majority used TC as a remedy for dermatophytosis (38%), followed by use as a fairness/cosmetic cream (20%). Most of patients (29.5%) used TC for 6 months duration. Most commonly used TC formulation was 0.05% clobetasol propionate (37.5%). Majority patients (62%) did not have a valid prescription of which 47% used TC on Quacks’s advice. The most common side effects encountered were tinea incognito (33%), steroid-induced acne (20.5%), hyperpigmentation (14.5%), and hypopigmentation in 22 (11%).Conclusions: Present study highlights irrational prescription of TC by non-dermatologists for dermatophytosis which are very common in this particular study region and emphasizes the need to educate patients about serious adverse effects of TC abuse.

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Tinea incognito: Report of two cases

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v6i3.4076 ◽

1970 ◽

Vol 6 (3) ◽

pp. 46-49

Author(s):

SK Kedia ◽

M Mathur

Keyword(s):

Case Report ◽

Fungal Infection ◽

Clinical Presentation ◽

Topical Steroid ◽

Medical Sciences ◽

Diagnostic Challenge ◽

Over The Counter ◽

Inappropriate Use ◽

General Physicians ◽

Tinea Incognito

Tinea incognito remains diagnostic challenge even to expert specialist because of modified clinical presentation caused by of inappropriate use of topical steroid. Topical steroid are being prescribed frequently for vary many dermatosis including fungal infection of skin and being used by patient as "over the counter drug" leading to varied clinical presentation of common dermatosis. This case report is of iatrogenic dermatosis that was invariably misdiagnosed by general physicians. Key words: Tinea incognito; dermatosis; fungal infection. DOI: 10.3126/jcmsn.v6i3.4076Journal of College of Medical Sciences-Nepal, 2010, Vol. 6, No. 3 pp.46-49

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Majocchi’s Granuloma in a Healthy Adult Man – a Case Report

Serbian Journal of Dermatology and Venerology ◽

10.1515/sjdv-2015-0004 ◽

2015 ◽

Vol 7 (1) ◽

pp. 34-40 ◽

Cited By ~ 2

Author(s):

Milan Bjekić ◽

Jasna Gajica Basara

Keyword(s):

World Literature ◽

Trichophyton Rubrum ◽

Topical Steroid ◽

Skin Lesions ◽

Hair Follicles ◽

Fungal Culture ◽

Direct Microscopy ◽

Topical Corticosteroids ◽

Tinea Incognito ◽

Majocchi’S Granuloma

Abstract Majocchi’s granuloma was first described by Domenico Majocchi in 1883, as a deep chronic dermatophyte infection of hair follicles, in which dermatophytes penetrate the dermis through hair canals, forming granulomatous changes in the dermis and/or hypodermis. Majocchi’s granuloma has two different clinical variants: the first is a small perifollicular papular type, seen in otherwise healthy individuals, that occurs secondary to trauma (e.g. in women with chronic tinea pedis that extends to the legs and who shave their legs); the second is a type with deep plaques or nodular lesions in immunocompromised hosts. The diagnosis is primarily made using direct microscopy of unstained specimens and fungal cultures, while additional diagnostics (histology, PCR) are generally not necessary. It is most commonly caused by Trichophyton rubrum. We present a 26-year-old otherwise healthy man exhibiting blue erythematous patches over the skin of his abdomen on clinical examination, which agglomerated to form slightly raised plaques with irregular ovoid contours, spreading from umbilicus to the pubic region; they were covered with multiple red-blue, erythematous partly coalescing scales, eroded, firm papules and nodules. On pressure, some nodules excreted viscid and turbid sero-purulent content. The lesions were slightly itchy. The patient was previously unsuccessfully treated during at least 4 weeks with a topical steroid cream prescribed by his physician. Direct microscopy for fungi of skin scrapings and pus mounted in potassium hydroxide was negative. Cultures of the contents and scrapings were performed on Sabouraud’s glucose agar and Trichophyton rubrum was isolated. The diagnosis of Majocchi’s granuloma was made, and the patient was treated with itraconazole (200 mg daily) for eight weeks, when all lesions resolved and fungal culture was negative. Misapplication of topical corticosteroids over a long period, as in our case, can produce Majocchi’s granuloma. When assessing skin lesions of unusual appearance, especially if aggravated by corticosteroids, dermatologists and general practitioners should consider tinea incognito, which may appear in its invasive form of Majocchi’s granuloma. The available world literature shows that Majocchi’s granuloma presenting as tinea incognito caused by topical corticosteroids has been reported extremely rarely.

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