Cortico-damage: topic steroid-modified dermatosis (Tinea incognito): A clinically striking case in the pediatric population
Keywords:
Tinea corporis, topical corticosteroids, steroid-induced damage, dermatophytosis, hyperpigmentation, antifungal treatmentAbstract
A 2-year-old female patient was referred for consultation due to dermatosis on the posterior aspect of her left forearm, which worsened after prolonged application of a combination topical cream (clotrimazole + betamethasone + gentamicin). Clinical progression was characterized by epidermal loss, hemorrhagic crusts, partial scarring, and severe pruritus, accompanied by febrile episodes that prompted medical consultation. Suspecting a secondary bacterial superinfection, oral antibiotic therapy with amoxicillin/clavulanic acid was initiated for 7 days, resulting in progressive improvement and resolution of the infectious component. Subsequent examination revealed an active desquamative lesion with residual hypopigmentation, consistent with steroid-modified tinea corporis, also referred to as tinea incognito. This case highlights the potential risks and complications derived from the inappropriate use of topical corticosteroids on undiagnosed dermatological conditions, with particular concern in pediatric patients. It also underscores the importance of conducting a thorough clinical and mycological assessment before treatment initiation to prevent mismanagement and disease progression.
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References
1. Kokandi AA. Tinea Incognito. Clin Cosmet Investig Dermatol. 2024 May 6;17:993-998. doi: 10.2147/CCID.S465942.
2. Coondoo A. Topical corticosteroid misuse: the Indian scenario. Indian J Dermatol. 2014 Sep;59(5):451-5. doi: 10.4103/0019-5154.139870.
3. Zacharopoulou, A., Tsiogka, A., Tsimpidakis, A., Lamia, A., Koumaki, D., & Gregoriou, S. (2024). Tinea Incognito: Challenges in Diagnosis and Management. Journal of Clinical Medicine, 13(11), 3267. https://doi.org/10.3390/jcm13113267
4. Totri CR, Eichenfield LF, Logan K, Proudfoot L, Schmitt J, Lara-Corrales I, Sugarman J, Tom W, Siegfried E, Cordoro K, Paller AS, Flohr C. Prescribing practices for systemic agents in the treatment of severe pediatric atopic dermatitis in the US and Canada: The PeDRA TREAT survey. J Am Acad Dermatol. 2017;76(2):281-5. doi:10.1016/j.jaad.2016.09.021.
5. Ely JW, Rosenfeld S, Seabury Stone M. Diagnosis and management of tinea infections. Am Fam Physician. 2014;90(10):702-11. PMID: 25403034.
6. Hengge UR, Ruzicka T, Schwartz RA, Cork MJ. Adverse effects of topical glucocorticosteroids. J Am Acad Dermatol. 2006;54(1):1-15. doi: 10.1016/j.jaad.2005.01.010.
7. Dhar S, Seth J, Parikh D. Systemic side-effects of topical corticosteroids. Indian J Dermatol. 2014;59(5):460-4. doi: 10.4103/0019-5154.139874.
8. Lahiri K, Coondoo A. Topical Steroid Damaged/Dependent Face (TSDF): An Entity of Cutaneous Pharmacodependence. Indian J Dermatol. 2016 May-Jun;61(3):265-72. doi: 10.4103/0019-5154.182417.
9. Gupta AK, Chaudhry M, Elewski B. Tinea corporis, tinea cruris, tinea nigra, and piedra. Dermatol Clin. 2003 Jul;21(3):395-400, v. doi: 10.1016/s0733-8635(03)00031-7. PMID: 12956194.
10. Gupta AK, Venkataraman M, Renaud HJ, Summerbell R. A Paradigm Shift in the Treatment and Management of Onychomycosis and Tinea Pedis. Skin Appendage Disord. 2021;7(5):351-358. doi: 10.1159/000516112.
11. Errichetti E, Stinco G. Dermoscopy in General Dermatology: A Practical Overview. Dermatol Ther (Heidelb). 2016;6(4):471-507. doi: 10.1007/s13555-016-0141-6.
12. Schäcke H, Döcke WD, Asadullah K. Mechanisms involved in the side effects of glucocorticoids. Pharmacol Ther. 2002;96(1):23-43. doi: 10.1016/s0163-7258(02)00297-8.
13. Dhaher S. Tinea incognito: Clinical perspectives of a new imitator. Dermatol Reports. 2020 Jun 25;12(1):8323. doi: 10.4081/dr.2020.8323. PMID: 32655844; PMCID: PMC7341072.
14. Dogra S, Uprety S. The menace of chronic and recurrent dermatophytosis in India: Is the problem deeper than we perceive? Indian Dermatol Online J. 2016 Mar-Apr;7(2):73-6. doi: 10.4103/2229-5178.178100. PMID: 27057485
15. Nenoff P, Verma SB, Vasani R, Burmester A, Hipler UC, Wittig F, Krüger C, Nenoff K, Wiegand C, Saraswat A, Madhu R, Panda S, Das A, Kura M, Jain A, Koch D, Gräser Y, Uhrlaß S. The current Indian epidemic of superficial dermatophytosis due to Trichophyton mentagrophytes: A molecular study. Mycoses. 2019 Apr;62(4):336-356. doi: 10.1111/myc.12878. Epub 2019 Feb 20.
16. 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(8):999-1003. doi:10.1111/j.1365-4632.2011.05049.x.
17. Lallas A, Kyrgidis A, Tzellos TG, Apalla Z, Karakyriou E, Karatolias A, et al. Accuracy of dermoscopic criteria for the diagnosis of psoriasis, dermatitis, lichen planus, and pityriasis rosea. Br J Dermatol. 2012;166(6):1198-205. doi: 10.1111/j.1365-2133.2012.10868.x.
18. Thomas J, Peterson GM, Christenson JK, Kosari S, Baby KE. Topical corticosteroid-induced skin atrophy: a comprehensive review. Drug Saf. 2015;38(5):493-509. doi: 10.1007/s40264-015-0287-7.
19. Halder RM, Nootheti PK. Postinflammatory hyperpigmentation and hypopigmentation. In: Kelly AP, Taylor SC, editors. Dermatology for Skin of Color. New York, NY: McGraw-Hill; 2009.
20. Gupta AK, Mays RR. The impact of onychomycosis on quality of life: A systematic review of the available literature. Skin Appendage Disord. 2018;4(4):208-216. doi: 10.1159/000485632.
21. Aubert-Wastiaux H, Moret L, Le Rhun A, Fontenoy AM, Nguyen JM, Leux C, Misery L, Young P, Chastaing M, Danou N, Lombrail P, Boralevi F, Lacour JP, Mazereeuw-Hautier J, Stalder JF, Barbarot S. Topical corticosteroid phobia in atopic dermatitis: a study of its nature, origins and frequency. Br J Dermatol. 2011 Oct;165(4):808-14. Epub 2011 Sep 15 doi: 10.1111/j.1365-2133.2011.10449.x.
22. Rathi SK, D'Souza P. Rational and ethical use of topical corticosteroids based on safety and efficacy. Indian J Dermatol. 2012;57(4):251-9. doi: 10.4103/0019-5154.97655.
23. Rudramurthy SM, Shankarnarayan SA, Dogra S, Shaw D, Mushtaq K, Paul RA, et al. Mutation in the Squalene Epoxidase Gene of Trichophyton interdigitale and Trichophyton rubrum Associated with Allylamine Resistance. Antimicrob Agents Chemother. 2018;62(5): e02522-17. doi: 10.1128/AAC.02522-17.
24. Arenas R. Dermatofitosis. In: Arenas R, editor. Dermatología. Atlas, Diagnóstico y Tratamiento. 7ª ed. Ciudad de México: McGraw-Hill; 2021. p. 505-518.
25. Leung AKC, Lam JM, Leong KF, Hon KL. Tinea Corporis: An Updated Review. Drugs Context. 2020; 9:2020-5-6. doi: 10.7573/dic.2020-5-6.
26. Kwak HB, Lee SK, Yoo HH, Lee IJ, Lee GJ, Nam KH, Yun SK, Park J. Facial tinea incognito: a clinical, dermoscopic and mycological study of 38 cases. Eur J Dermatol. 2023 Apr 1;33(2):101-108. doi: 10.1684/ejd.2023.4450.
27. Kaushik N, Pujalte GG, Reese ST. Superficial Fungal Infections. Prim Care. 2015;42(4):501-16. doi: 10.1016/j.pop.2015.08.004.
28. Rajagopalan M, Inamadar A, Mittal A, Miskeen AK, Srinivas CR, Sardana K, et al. Expert Consensus on The Management of Dermatophytosis in India (ECTODERM India). BMC Dermatol. 2018;18(1):6. doi: 10.1186/s12895-018-0073-1.
29. Rotta I, Ziegelmann PK, Otuki MF, Riveros BS, Bernardo NL, Correr CJ. Efficacy of topical antifungals in the treatment of dermatophytosis: a mixed-treatment comparison meta-analysis involving 14 treatments. JAMA Dermatol. 2013 Mar;149(3):341-9. doi: 10.1001/jamadermatol.2013.1721.
30. Gupta, A. K., Susmita, Nguyen, H. C., Liddy, A., Economopoulos, V., & Wang, T. (2025). Terbinafine Resistance in Trichophyton rubrum and Trichophyton indotineae: A Literature Review. Antibiotics, 14(5), 472. https://doi.org/10.3390/antibiotics14050472
31. Hogade S, Chavan S, Verekar V, Pandya A, Annigeri AR, Hogade T. Clinicomycological correlation of tinea incognito. J Mycol Infect. 2024;29(4):181. Epub 2025 Jan 3 doi:10.17966/JMI.2024.29.4.181.
32. Verma SB, Panda S, Nenoff P, Singal A, Rudramurthy SM, Uhrlass S, Das A, Bisherwal K, Shaw D, Vasani R. The unprecedented epidemic-like scenario of dermatophytosis in India: III. Antifungal resistance and treatment options. Indian J Dermatol Venereol Leprol. 2021;87(4):468-82. doi:10.25259/IJDVL_303_20.
33. del Boz J, Crespo V, Rivas-Ruiz F, de Troya M. Tinea incognito in children: 54 cases. Mycoses. 2011;54(3):254-8. doi:10.1111/j.1439-0507.2009.01810.x.
34. Gupta AK, Venkataraman M, Hall DC, Cooper EA, Summerbell RC. The emergence of Trichophyton indotineae: implications for clinical practice. Int J Dermatol. 2022. doi:10.1111/ijd.16362.
35. Rotta I, Ziegelmann PK, Otuki MF, Riveros BS, Bernardo NL, Correr CJ. Efficacy of topical antifungals in the treatment of dermatophytosis: a mixed-treatment comparison meta-analysis involving 14 treatments. JAMA Dermatol. 2013;149(3):341-9. doi:10.1001/jamadermatol.2013.1721.
36. Leung AKC, Lam JM, Leong KF, Hon KL. "Tinea Corporis: An Updated Review." Drugs Context. 2020;9:2020-5-6. doi:10.7573/dic.2020-5-6.
37. Dogra S, Shaw D, Rudramurthy SM. Antifungal drug susceptibility testing of dermatophytes: laboratory findings to clinical implications. Indian Dermatol Online J. 2019;10(3):225-33. doi:10.4103/idoj.IDOJ_146_19.
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