---
title: "Tinea incognito presenting as erythematous pustular facial plaques in a 38-year-old woman"
id: "cmaj-4-a-38-year-old-woman-with-tinea-incognito-practice"
canonical_url: "https://medichelpline.com/clinical-feed/cmaj-4-a-38-year-old-woman-with-tinea-incognito-practice"
content_type: "clinical_feed_article"
specialty: "General"
source_name: "CMAJ"
source_url: "http://www.cmaj.ca/cgi/content/short/198/29/E1159?rss=1"
published_at: "2026-08-24T04:05:24.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Tinea incognito presenting as erythematous pustular facial plaques in a 38-year-old woman
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/cmaj-4-a-38-year-old-woman-with-tinea-incognito-practice
- **Specialty:** [General](https://medichelpline.com/clinical-feed/general.md)
- **Primary Source:** CMAJ
- **Source URL:** [Original Journal Publication](http://www.cmaj.ca/cgi/content/short/198/29/E1159?rss=1)
- **Published At:** 2026-08-24T04:05:24.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- A 38-year-old woman developed slowly progressive **erythematous plaques** with interspersed pustules on the malar region and forehead over 8 months. Initial lesions were slightly scaly and central to the midface. - The eruption was first diagnosed as eczema and treated with topical mometasone, which produced rapid clearing but the rash recurred within 2 weeks with added pustules. - Clinical morphology raised differential diagnoses including cutaneous lupus erythematosus (malar distribution) and pustular psoriasis (pustules). - Punch biopsy from the right cheek revealed spongiosis, subcorneal bullae and fungal hyphae in the stratum corneum on periodic acid–Schiff (PAS) staining; Grocott–Gömöri methenamine silver stain also showed fungal hyphae. - Histology led to the diagnosis of **pustular tinea incognito**, a dermatophytosis modified by prior topical corticosteroid use. - Treatment comprised discontinuation of topical corticosteroids and initiation of oral **itraconazole** 200 mg plus topical **luliconazole** 1% cream twice daily, with complete resolution of erythema and pustules within 7 days. - The report highlights that topical corticosteroid use, including over-the-counter fixed-dose steroid creams, is a major driver of tinea incognito and can produce atypical morphologies (bullous, lichenoid, rosacea-like, pustular psoriasis–like, eczema-like) that complicate diagnosis. - Clinicians should consider a fungal eruption when seeing an erythematous circular plaque with a raised scaly border and perform skin scraping for **potassium hydroxide (KOH)** examination to detect fungal hyphae. - References cited in the report discuss challenges in diagnosis and management of tinea incognito, atypical presentations of superficial mycoses, and updates on dermatophyte epidemiology and treatment.
## Clinical Analysis & Structured Key Points
A 38-year-old woman with tinea incognito | CMAJ Skip to main content Log in Toggle navigation menu Open settings menu Open search Advanced Search Advanced Search Log in --> A 38-year-old woman with tinea incognito Avinash Jadhav Avinash Jadhav Department of Dermatology, Dr. D.Y. Patil Medical College Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth University, Pune, Maharashtra, India. MBBS MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Kirti Deo Kirti Deo Department of Dermatology, Dr. D.Y. Patil Medical College Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth University, Pune, Maharashtra, India. MBBS MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site and Vishavjit Singh Vishavjit Singh Department of Dermatology, Dr. D.Y. Patil Medical College Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth University, Pune, Maharashtra, India. MBBS Find this author on Google Scholar Find this author on PubMed Search for this author on this site CMAJ August 24, 2026 198 (29) E1159-E1160; DOI: https://doi.org/10.1503/cmaj.260512 PDF Help Article Figures & Tables Related Content Responses Metrics PDF A 38-year-old woman presented to our outpatient dermatology clinic with multiple erythematous plaques with interspersed pustules predominantly over the malar region and forehead, which had been gradually progressing over the past 8 months ( Figure 1A ). The patient had initially noticed slightly scaly erythematous lesions over the central midface. She had no prior history of photosensitivity or medications and no previous or family history of psoriasis. The eruption was initially diagnosed as eczema, and she was advised to apply topical mometasone. Her lesions resolved within 5 days, and she discontinued the treatment; however, the eruption gradually reappeared over 2 weeks, this time with scattered pustules. Download figure Open in new tab Download PowerPoint Figure 1: (A) Multiple erythematous plaques with interspersed pustules over the malar region and forehead of a 38-year-old woman. (B) Resolution of the erythematous plaques following 7 days of oral and topical antifungal therapy. The presence of a symmetric erythematous malar rash suggested cutaneous lupus erythematosus, and the pustular lesions indicated pustular psoriasis. For confirmation, we sent a punch biopsy from lesions over the right cheek for histologic evaluation. Surprisingly, periodic acid–Schiff staining revealed spongiosis, subcorneal bullae, and fungal hyphae in the stratum corneum. Similarly, tissue sections stained with Grocott–Gömöri methenamine silver stain revealed black-coloured fungal hyphae, following which we made a diagnosis of pustular tinea incognito (Appendix 1, available at www.cmaj.ca/lookup/doi/10.1503/cmaj.260512/tab-related-content ). We started the patient on oral itraconazole 200 mg and topical luliconazole 1% cream twice daily, leading to the complete resolution of erythema and pustules in a week ( Figure 1B ). Topical corticosteroid application over dermatophytosis (fungal infections) can lead to tinea incognito. The presentation can be bullous, lichenoid, rosacea-like, pustular psoriasis–like, or eczema-like, posing a substantial diagnostic dilemma to clinicians. 1 , 2 Over-the-counter fixed-dose creams with potent corticosteroids are the major drivers for this disease. 1 Treatment includes the discontinuation of topical corticosteroids and the use of oral and systemic antifungals. 1 , 3 An erythematous circular plaque with a raised scaly border in a patient should alert the clinician to the possibility of a fungal eruption, and skin scraping for potassium hydroxide mount can identify fungal hyphae. Footnotes Competing interests: None declared. This article has been peer reviewed. The authors have obtained patient consent. This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/ References 1 ↵ Zacharopoulou A Tsiogka A Tsimpidakis A . Tinea incognito: challenges in diagnosis and management . J Clin Med 2024 ; 13 : 3267 . Google Scholar OpenURL PubMed 2 ↵ Belmokhtar Z Djaroud S Matmour D . Atypical and unpredictable superficial mycosis presentations: a narrative review . J Fungi (Basel) 2024 ; 10 : 295 . Google Scholar OpenURL PubMed 3 ↵ Barac A Stjepanovic M Krajisnik S . Dermatophytes: update on clinical epidemiology and treatment . Mycopathologia 2024 ; 189 : 101 . Google Scholar OpenURL PubMed PDF Previous Next Back to top In This Issue CMAJ Vol. 198, Issue 29 24 Aug 2026 Table of Contents Index by author Article tools Respond to this article Print Download PDF Article Alerts Alerts for this Article User Name * Password * To sign up for email alerts or to access your current email alerts, enter your email address below: Email * Email Article Email This Article Thank you for your interest in spreading the word on CMAJ. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address. Your Email * Your Name * Send To * Enter multiple addresses on separate lines or separate them with commas. You are going to email the following A 38-year-old woman with tinea incognito Message Subject (Your Name) has sent you a message from CMAJ Message Body (Your Name) thought you would like to see the CMAJ web site. Your Personal Message CAPTCHA Please verify that you are a real person Close Citation Tools Citation Tools A 38-year-old woman with tinea incognito Avinash Jadhav Avinash Jadhav Kirti Deo Kirti Deo and Vishavjit Singh Vishavjit Singh CMAJ Aug 2026, 198 (29) E1159-E1160; DOI: 10.1503/cmaj.260512 Citation Manager Formats BibTeX Bookends EasyBib EndNote (tagged) EndNote 8 (xml) Medlars Mendeley Papers RefWorks Tagged Ref Manager RIS Zotero Request Permissions Share Share This Article A 38-year-old woman with tinea incognito Avinash Jadhav Avinash Jadhav Kirti Deo Kirti Deo and Vishavjit Singh Vishavjit Singh CMAJ Aug 2026, 198 (29) E1159-E1160; DOI: 10.1503/cmaj.260512 Share This Article: Copy Post Like 0 Jump To Section Footnotes References PDF Related Articles No related articles found. Google Scholar PubMed Cited By... No citing articles found. 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