Dermoscopic Distinction of Tinea Incognito on the Face and Topical Steroid Damaged Face: A Cross-Sectional Study in Skin of Color.

Background: Dermatophytosis is widespread in India due to recalcitrant and resistant infection. Tinea incognito (TI) is modified dermatophytosis due to the inadvertent use of topical steroids (TS). Similarly, topical steroid-damaged face (TSDF) is caused by prolonged use of TS. Distinction of TI and TSDF is difficult when the face is affected. Dermoscopy can assist in the differentiation of both by revealing characteristic features. We evaluated the dermoscopic features in TI affecting the face and TSDF.

Aims and objectives: To evaluate the clinical and dermoscopic features of TI affecting the face and TSDF. To observe the involvement of eyelids in TI as opposed to TSDF.

Materials and methods: The study was conducted in a tertiary hospital after obtaining ethical clearance and informed consent. Patients with signs of TI or TSDF were enrolled and demographic data were collected. Patients who had applied TS/combination creams were included. A handheld dermoscope with 10x magnification was used. A potassium hydroxide mount was used to confirm the diagnosis of TI.

Results: Out of 80 patients, 27 males and 53 females were present. The mean duration of application was 8.25 ± 7 months. Clinical features were pruritus, erythema, scaling, and burning sensation. Eyelid involvement was noted in TI while it was spared in TSDF. On dermoscopy, morphological features were predominant in TI whereas vascular structures were found in TSDF in addition to white rosettes.

Conclusion: Dermoscopy distinguishes TI from TSDF comprehensively by demonstrating definitive features. In addition, the involvement of the eyelid is an excellent clinical sign of TI.