Steroid modified tinea
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CE - MEDICAL ILLUSTRATION
Steroid modified tinea Michele Spinicci1,2 · Francesca Rinaldi1 · Lorenzo Zammarchi1,2 · Alessandro Bartoloni1,2 Received: 4 February 2020 / Accepted: 7 March 2020 © Società Italiana di Medicina Interna (SIMI) 2020
A 56-year-old man, member of a Hare Krishna community, presented with a longstanding, intensely pruritic eruption on his neck and thorax, developed along 15 months. The eruption firstly appeared on the neck and gradually spread in craniocaudal direction, covering both the shoulders and the anterior side of the chest. At the time of the access to the outpatients’ service, the lesion had a well-marked, erythematous advancing edge, without signs of central clearing (Fig. 1). The patient reported a dramatic itching, especially in the night, which disrupted his sleep. Nevertheless, he did not take any oral drug, but an unspecified ayurvedic compound. Moreover, he reported the application of a corticosteroid-antifungal cream (miconazole and fluprednidene), with minimal relief of pruritus. Physical examination was unremarkable, except for evidence of tinea pedis involving all the interdigital web spaces. Culture of skin scraping from the trunk lesion was positive for Trichophyton spp. Common causes of immunosuppression, including HIV, were ruled out. The patients received oral fluconazole 100 mg daily during 7 days, then 150 mg twice a week, for a total of 8 weeks. The itching rapidly improved and the eruption progressively discoloured, until disappearing at the end of the treatment. Tinea pedis was also resolved. Tinea is a superficial fungal infection caused by dermatophytes. The use of immunosuppressive drugs, typically topical corticosteroids or steroid-containing antifungal creams, can modify the clinical pathomorphosis, producing bizarre shapes, size and course, or mimic other diseases such as eczema, atopic dermatitis, contact dermatitis, rosacea and psoriasis [1]. Furthermore, it increases the risk of treatment failure, recurrence and antifungal resistance [2]. Therefore,
topical or systemic steroids should be avoided in patients with suspicion of tinea, even in association with antifungal drugs. Acknowledgments We thank Prof. Elisa Difonzo for her expert advice. Author contributions MS wrote the manuscript. All authors contributed to the patient’s care and critical review of the manuscript. Funding None.
Compliance with ethical standards Conflict of interest We declare no competing interests. Statement of human and animal rights This article does not contain any studies with human participants or animals performed by any of the authors. Informed consent For this type of study formal consent is not required. However, the patient provided signed informed consent for publication.
References 1. Verma S (2017) Steroid modified tinea. BMJ 356:j973 2. Schaller M, Friedrich M, Papini M, Pujol RM, Veraldi S (2016) Topical antifungal-corticosteroid combination therapy for the treatment of superficial mycoses: conclusions of an expert panel meeting. Mycoses 59(6):365–373 Publi
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