Tinea incognito skin lesions worsen after antifungal treatment: Atypical tinea appearing twice in a case: A case report.

RATIONALE

Atypical tinea lesions can exhibit diverse manifestations. Positive fungal microscopy results confirmed the diagnosis of tinea incognito and other forms of atypical tinea. Patients may concurrently suffer from fungal and bacterial coinfections, requiring physicians to carefully observe, accurately assess, and implement treatments that target both fungi and bacteria.

PATIENT CONCERNS

After a 10-month period of misdiagnosis, fungal elements were identified upon examination, suggesting a possible breakthrough in diagnosis. However, the worsening of skin lesions following antifungal treatment raises concerns regarding alternative diagnoses. Subsequent antifungal and antibacterial therapies have led to the resolution of facial skin lesions. However, the fungal and bacterial infections recurred after reusing the same skincare products. This relapse highlighted the potential role of external contaminants in disease recurrence. Fortunately, the infection was successfully eradicated with appropriate treatment.

DIAGNOSES

Based on the positive fungal microscopy result, the patient was diagnosed with tinea incognito. However, the skin lesions worsened after the antifungal treatment. Given the emergence of multiple small papulopustular lesions, an additional diagnosis of folliculitis was established. Two weeks after achieving a clinical cure with treatment, the skin lesions recurred. The physician determined that this was caused by a facial infection from contaminated skincare products, leading to a rediagnosis of atypical tinea and folliculitis.

INTERVENTIONS

The initial treatment involved antifungal therapy alone. Antibacterial therapy was administered after the skin lesions worsened. When the lesions recurred 2 weeks following their resolution and antifungal monotherapy failed to achieve complete clearance, antibacterial treatment was reintroduced.

OUTCOMES

After the initial combined antifungal and antibacterial therapy, the skin lesions resolved completely. Two weeks later, when the lesions recurred, antifungal treatment was administered first, followed by antibacterial therapy. This sequential approach ultimately cleared the lesion.

LESSONS

Diagnosis of tinea incognito relies on positive fungal microscopy results. When papulopustular lesions emerge following antifungal treatment, the possibility of concurrent bacterial infections should be considered. Essential therapeutic interventions require both antifungal and antibacterial therapies. Contaminated skincare products must be identified and eliminated to prevent the recurrence of fungal and bacterial infections. Empirical therapy is warranted when prompt therapeutic decisions are needed pending delayed fungal/bacterial test results.