A comparative study of morphological characteristics of dermatophytosis among treatment naive and those who have abused topical corticosteroids/combination experience

Introduction Dermatophytosis is a commonly encountered superficial fungal infection with alarmingly increasing prevalence especially in hot, humid areas. Misuse of topical corticosteroids has led to varying appearance of dermatophytosis leading to diagnostic dilemma and inappropriate treatment. Objectives This study was undertaken to compare morphological patterns of dermatophytosis among treatment naive and those who have abused topical corticosteroids/ combination in a tertiary care hospital. Materials and methods 200 patients clinically diagnosed as dermatophytosis were included in this prospective, descriptive, observational study. Results 110 patients had used topical steroid/ combination therapy and 90 were treatment naive patients. There were increased number of lesions in tinea topical steroid group. Atypical presentation due to steroid application included more irregularity in margins(63.33%), loss of central clearing(83.6%), reduction in scaling(94.5%), secondary features: excoriation(82.5%), pustules(100%), striae(100%), telangiectasia(100%), impetiginization(99%) which persisted post treatment. Papules and oval shape of lesions with irregular margin was significantly higher among topical steroid/combination group. Conclusion Chronic dermatophytoses post application of topical steroids are a menace due to atypical presentation and delay in diagnosis. Diagnosing these cases early is important as clinical failure to existing antifungal therapy is being witnessed. This study highlights the clinical patterns and morphology which may be used reliably as a predictor of topical steroid abuse.