Tietze syndrome - a case report of 20 year old male patient with steroid induced tinea incognito

Tietze syndrome is a self-limiting, rare and benign condition that might be mistaken with potentially fatal chest diseases and misdiagnosed mostly as costochondritis. This disease is most often diagnosed in young individuals under the age of 40, with painful, localized inflammation.Tinea incognito is a ringworm infection that has been altered by corticosteroids and other immunosuppressive medications. Corticosteroids are administered for pre-existing illness or are used incorrectly for the treatment of tinea. We report a case of 20years old male patient admitted in emergency department with complaints of chest pain and SOB with normal ECG while neutrophils, ESR, CRP have found to be abnormal. Patient has been using steroids and itraconazole for maculopapular rashes in lower limb since 1year. Other diagnostic methods such as CT, MRI should be performed to avoid misdiagnosis. He was prescribed with NSAIDS, antifungals, antihistamines and other supportive measures which helped him to relieve from pain. Proper diagnostic criteria and early diagnosis remain challenging tasks, resulting in undue treatment costs for patients. Before confirming a diagnosis, other underlying diseases should be ruled out.

Clinico-epidemiological study and microbiological correlation of tinea incognito at a tertiary care hospital

Tinea incognito also known as steroid-modified tinea are dermatophytic infections modified by the use of topical or systemic corticosteroids. Dermatophytic infection being very common and very simple to diagnose, is a diagnostic dilemma due to steroid abuse. Hence making a simple curable infection into a chronic persistent dermatological condition. As a treating doctor it’s important to recognize and educate the patients regarding the tinea infections and steroid abuse. To study the various morphological presentations, epidemiology and etiological agent of tinea incognito. An observational study was performed with 100 cases from 2017 to 2019 in the department of Dermatology & Venerology, SS Institute of Medical Sciences and Research, Davangere, Karnataka, India. The baseline data, thorough general physical, local, and systemic examination were done with reference to clinical features of tinea incognito. Skin scraping were collected and subjected to potassium hydroxide (KOH) preparation. The part of the sample was inoculated into Sabouraud’s Dextrose Agar (SDA) media for fungal culture. Later the fungus was identified by standard techniques. The mean age of study population was 32.83 years. The males outnumbered females in our study. Almost 29% cases remain asymptomatic followed by 34% itching and 37% burning sensation. The source of drug responsible for tinea incognito were highly suggested by friends (29%) with the combination use of drugs account for 35% of study population. 77% cases showed erythema followed by 48% of hypopigmentation. The scraping of lesion showed positive KOH mount in 71% and T.mentagrophytes were the most common dermatophyte grown in SDA medium. Misuse of steroid formulations in dermatophytic infections may lead to adverse effect as well as chronicity. Awareness of this problem is needed for prevention of steroid modified dermatophytosis, which is a rising menace.

Improper Use of Topical Corticosteroids in Tinea Infections in a Tertiary Care Hospital

Background: Steroid-modified tinea, also known as tinea incognito, is an infection by the dermatophytes, where the clinical morphology is modified due to corticosteroids, either systemic or topical. Rampant use of topical corticosteroids has led to increasing recurrence in tinea infections. Methods: All consenting cases of tinea presenting to outpatient department of dermatology department of Civil Service Hospital from March to August 2020 for a total of 6 months were included in this study. Tinea infection involving only the palms, soles, nails or scalp were excluded.Results: A total of 200 patients were included in this study. Among these, 175 patients (87.5%) were using topical corticosteroids. A significant association was noted between dermatophyte infection of more than one month and topical corticosteroids use (p<0.05). This study revealed that males were using super-potent topical corticosteroids more as compared to females (p<0.05). Moreover, no association was noted between the level of education attained and the use of topical corticosteroids (p=0.91). Only 25 (12%) patients were either using correct or no topical medications during the time of consultation with the dermatologist. Among the patients using topical corticosteroids, 155 (88.6%) patients were using them on recommendation of the local pharmacist and only 2 (1.2%) patients were prescribed by a physician. Conclusions: In short, use of topical steroids was rampant among patients with tinea whilst 77.5% patients procured steroid topicals over-the-counter. Hence, a tougher law and strict regulatory guidelines deemed necessary to curb the unauthorized and rampant sale of these medicines.Keywords: Dermatophytes; over-the-counter; steroid misuse; self-medications; tinea; topical corticosteroid

A study on the clinical profile of dermatoses induced by topical corticosteroids

<p class="abstract"><strong>Background:</strong> Topical corticosteroids (TC), commonly used for a wide range of skin disorders, are associated with many side effects with their overuse, abuse and over-the-counter use as a cosmetic. This article aims to study clinical presentation of various dermatoses induced by abuse of TC in order to bring awareness among patients and practitioners to use topical corticosteroids with utmost caution.</p><p class="abstract"><strong>Methods:</strong> This study was conducted at DVL department of a tertiary care teaching hospital over 23 consecutive months. A total of 200 consecutive patients of all ages and both genders with topical steroid induced dermatoses were included in the study. A detailed clinical evaluation was undertaken, data was then recorded and analysed.</p><p class="abstract"><strong>Results:</strong> Majority of the patients were females (56%). Most common age group was 20-29 years (42%). Majority used TC as a remedy for dermatophytosis (38%), followed by use as a fairness/cosmetic cream (20%). Most of patients (29.5%) used TC for 6 months duration. Most commonly used TC formulation was 0.05% clobetasol propionate (37.5%). Majority patients (62%) did not have a valid prescription of which 47% used TC on Quacks’s advice. The most common side effects encountered were tinea incognito (33%), steroid-induced acne (20.5%), hyperpigmentation (14.5%), and hypopigmentation in 22 (11%).</p><p class="abstract"><strong>Conclusions:</strong> Present study highlights irrational prescription of TC by non-dermatologists for dermatophytosis which are very common in this particular study region and emphasizes the need to educate patients about serious adverse effects of TC abuse.</p>

A study on abuse of topical corticosteroids in patients who attended dermatology venerology leprosy outpatient department

Background: Topical corticosteroids (TCs) are widely used in the patients affected with dermatoses. Abuse of these agents may cause severe adverse effects. Aim of the study was to study the abuse of TCs in patient who attend Dermatology, Venereology, and Leprosy (DVL) outpatient department. Methods: This prospective observational study was conducted in department of DVL at Rajah Muthiah Medical college, Tamil Nadu during the period of six months from November 2018 to April 2019. The patients were enrolled for the study based on inclusion and exclusion criteria.Results: Totally 50 patients with adverse drug reactions (ADRs) by the abuse of TCs were enrolled for the study. It was found that TCs were abused in all ages and equally in both genders. Nearly 72% of the people used TCs for Tinea infection and 20% of the people used TCs for acne vulgaris. Very high potent TCs such as betamethasone and beclomethasone were abused by 55% of the patient. Tinea incognito (TI) was found as common ADRs by the abuse of TCs (74%). Nearly 88% of the people bought TCs from pharmacies without prescription. Sixteen brands were found as easily accessible and affordable for the patients. Medication adherence were increased by 60% after the patient counselling.Conclusion: This study concludes, TI was found as a common ADR in patients who abused TCs such as betamethasone, beclomethasone and clobetasol. High potent TCs should not be allowed to dispense without prescription. Withdrawal of TCs will reduce the risk of ADRs.

Tinea incognito: Clinical perspectives of a new imitator

Tinea incognito is a variant of dermatophyte infection of the skin modified by an erroneously applied topical or systemic steroid. Aim of the study: to describe the various clinic-epidemiological aspects of tinea incognito found among our patients. A prospective study was carried out in the Department of Dermatology, Basra Teaching Hospital, Basra, Iraq. The clinical diagnosis was confirmed by mycological tests. Clinical data were described in more detail and the lesions were classified according to the site, shape, and extent. Ninety cases of tinea incognito were seen, median age was 34years. The initial inaccurate diagnoses were eczema in 60 patients (67%), intertrigo in 16 (18 %) and psoriasis in 14 (15%) patients. The type of topical drugs applied was topical corticosteroid (potent and fluorinated) in most cases (54.4%), fixed drug combination creams in 36.6% and a topical calcineurin inhibitor in 5.5%. Commonly presented as acute eczema-like, on hands and trunk, discoid lupus erythematosus-like lesions on the face and psoriasiform lesions on the scalp. Due to the wide range of clinical manifestations, tinea incognito imitates many skin diseases and should, therefore, be considered in any chronic, erythematous, scaly skin lesions not responding to topical treatment.