What are the other Names for this Condition? (Also known as/Synonyms)

• Steroid-Modified Tinea
• Tinea Incognito

What is Tinea Incognita? (Definition/Background Information)

• Tinea Incognita is described as a fungal infection of skin that has been masked with clinical features obliterated and made much worse through inappropriate treatment, typically by using topical steroidal agents, following a misdiagnosis. Hence, it is also known as Steroid-Modified Tinea
• The condition can lead to the appearance of less prominent pustular lesions and skin atrophy. The management of Tinea Incognita involves an immediate discontinuation of steroid medications followed by the administration of antifungals. The prognosis of the condition is generally good with proper treatment

Who gets Tinea Incognita? (Age and Sex Distribution)

• Tinea Incognita may be observed in individuals of any age category
• Both males and females are affected
• Worldwide, there is no racial or ethnic preference observed

What are the Risk Factors for Tinea Incognita? (Predisposing Factors)

The risk factors for Tinea Incognita include:

• Misdiagnosis of fungal infections as dermatitis or other skin conditions followed by treatment with topical steroid agents is the primary risk factor for Tinea Incognita. The condition may be also caused by systemic steroidal medications
• Other anti-inflammatory creams and ointments used inappropriately in treating fungal infections that may result in Tinea Incognita include tacrolimus and pimecrolimus
• Other contributory factors include minor trauma, abrasion, or sweating
• Some individuals are at a higher risk for Tinea Incognita from the following factors:
  • Immunocompromised status due to HIV infection or AIDS
  • Use of immunosuppressants
  • Poorly-controlled diabetes

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Tinea Incognita? (Etiology)

Dermatophytic (tinea) fungal infections treated inappropriately using topical steroids, possibly from a misdiagnosis, result in Tinea Incognita.

• Such topical applications may temporarily help improve the symptoms, such as inflammation, without treating the actual infection. When the symptoms get worse, the topical agents are used again
• This leads to a worsening of the original infection (usually tinea corporis), even though its clinical appearance may not resemble conventional skin fungal infections any more
• The longer is the use of topical steroids, the more severe and widespread it develops to become, even if antifungal agents are applied in addition to the steroids

What are the Signs and Symptoms of Tinea Incognita?

The signs and symptoms of Tinea Incognita may vary from one individual to another. It may include:

• The skin lesions have poorly-defined boundaries and are less prominently seen
• Inflammation is minimal, and there is less scaling noted
• However, the skin area of involvement may be extensive
• The lesions may become more pustular (blister-like)
• Irritation and discomfort
• Atrophy of skin
• Bleeding into the skin resulting in purpura with appearance of capillaries (telangiectasia)

How is Tinea Incognita Diagnosed?

A diagnosis of Tinea Incognita may involve the following exams and procedures:

• Physical examination of the individual and medical history evaluation, including assessing usage of topical agents and individual’s immune status
• Blood tests and fungal culture (obtained after stopping the offending topical agent for a few days)
• Dermoscopy: Dermoscopy is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Skin biopsy, if necessary: A skin tissue biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Tinea Incognita?

The possible complications due to Tinea Incognita may include:

• Emotional stress due to cosmetic issues
• Superimposed bacterial infections
• Impetigo
• Recurrence of the condition following treatment
• Treatment complications and side effects

How is Tinea Incognita Treated?

The treatment measures available for Tinea Incognita include:

• Immediate stoppage of topical and systemic steroids, if being used
• Treat any underlying condition that causes poor immunity, where possible
• Antifungal medications and applications such as ketoconazole
• Oral antifungal medications, such as terbinafine, for more extensive infections

Regular follow up visits with the healthcare provider is important and recommended.

How can Tinea Incognita be Prevented?

Tinea Incognita may be prevented by considering the following steps:

• Avoid self-medication of skin infections using topical applications such as steroidal creams
• Avoid misdiagnosis of skin condition by undertaking proper tests and examinations, as necessary
• Undertake early diagnosis and/or treatment of any condition causing poor immunity, where possible

What is the Prognosis of Tinea Incognita? (Outcomes/Resolutions)

The prognosis of Tinea Incognita is generally good with early recognition of the condition followed by appropriate treatment.

Additional and Relevant Useful Information for Tinea Incognita:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/skin-disorders/