Case History : 1


A 15 year old boy visited with a complaint of itchy skin lesions (shown in the adjacent figure)

Appearance of the lesions was in the form of multiple, discrete to confluent annular plaques arranged in concentric circles

He had such lesions for past 2 months

He was using topical steroid for past one month as prescribed by a local practitioner

No improvement in symptoms observed Based

Based on his symptoms and the appearance of lesions, which of the following conditions he is suffering from?


Eczema

Tinea corporis

Psoriasis


Right Answer


Dermatophytosis infections are increasing at high rates since recent past. Also, there is increase in atypical morphological patterns which may lead to misdiagnosis particularly by a general practitioner. Widespread use of steroids and self medication have led to the evolution of an atypical presentation of dermatophytosis namely tinea incognito. Its one of the subsets, tinea psudoimbricata, has a characteristic appearance of multiple concentric rings. Confirmation of the disease should be done with KOH staining.

Wrong Answer


Eczema - Atopic dermatitis (eczema) is a scaly, itchy rash that often affects the face, elbows and knees and appears periodically. It does not match with the given patient symptoms.

Wrong Answer


Tinea corporis - Ringworm of the body (tinea corporis) is a rash caused by a fungal infection. It's usually a red, itchy, circular rash with clearer skin in the middle. It does not match with the given patient symptoms

Wrong Answer


Psoriasis - Psoriasis is diagnosed with well-demarcated, symmetric, and erythematous plaques with overlying silvery scale. Plaques are typically located on the scalp, trunk, buttocks, and extremities but can occur anywhere on the body. Patients might demonstrate nail involvement, which can present without concomitant plaques. Active lesions might be itchy or painful. It does not match with the given patient symptoms

1. Singal a, jakhar d, kaur i, et al. Tinea pseudoimbricata as a unique manifestation of steroid abuse: a clinico-mycological and dermoscopic study from a tertiary care hospital. Indian dermatology online journal. 2019 jul;10(4):422.

2. Eczema: overview. Available from: https://www.ncbi.nlm.nih.gov/books/nbk279399/. Accessed on: 24th april, 2020.

3. Psoriasis is an immune-mediated disease that causes raised, red, scaly patches to appear on the skin. Available from: https://www.psoriasis.org/about-psoriasis. Accessed on: 4th May 202