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

Summary

A young woman had a persistent facial rash for 10 months that was initially misdiagnosed as dermatitis because early fungal tests were negative. When fungal testing was repeated, it finally confirmed a fungal infection (tinea incognito) caused by contact with a dog. Treatment with antifungal medication alone initially worsened the condition by causing bacterial infection, but combining antifungal and antibiotic medications resolved it. The infection returned after using the same contaminated skincare products, but was successfully treated again with the combined medication approach.

Background

Tinea incognito (TI) is an atypical form of fungal infection that appears unusual due to topical corticosteroid or immunosuppressant use. A 25-year-old female presented with facial erythematous papulopuritic lesions persisting for 10 months after contact with a pet dog undergoing hair epilation. Initial fungal microscopy tests were negative, leading to misdiagnosis as dermatitis.

Objective

This case report documents the diagnostic and therapeutic challenges in managing tinea incognito with concurrent bacterial coinfection, including recurrence despite initial successful treatment.

Results

Repeat fungal microscopy revealed positive results with atypical hyphae, confirming TI diagnosis. Antifungal monotherapy was followed by emergence of papulopustular lesions indicating secondary bacterial folliculitis. Combined antifungal and antibacterial therapy achieved complete resolution by week 4. Lesions recurred at week 6 due to contaminated skincare products and were successfully treated with repeat antifungal followed by antibacterial therapy.

Conclusion

Accurate diagnosis of tinea incognito requires repeated fungal microscopy and careful clinical assessment. Concurrent fungal-bacterial coinfections require combination therapy. Contaminated fomites must be eliminated to prevent recurrence. Empirical antifungal and antibacterial therapy is warranted when prompt therapeutic decisions are needed.
  • Published in:Medicine (Baltimore),
  • Study Type:Case Report,
  • Source: PMID: 40826792, DOI: 10.1097/MD.0000000000043875
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