Answer to last month's Clinical Quiz

Question:
This middle aged man complained of an itchy rash on his neck for one month. He had applied a cream bought from the dispensary without any improvement and the rash progressed to involve his face.

Answer: B. Tinea faciei

This annular scaly eruption with active border and central clearing is typical of tinea infection. Facial skin may be infected either by direct inoculation of fungus from tinea of another body site or from an infected pet. In this case the responsible organism is Trichophyton rubrum, originating from the patient's tinea pedis.

This condition is commonly mistaken for dermatitis and topical steroids are prescribed. This will not only worsen the condition, but also makes the diagnosis and the treatment more difficult. The name 'tinea incognito' is sometimes applied to steroid-modified ringworm infection as the typical morphology of ringworm infection is obscured.

For uncomplicated tinea faciei, topical imidazoles are usually effective. Systemic antifungal agents like griseofulvin are necessary for treatment of steroid-modified tinea faciei.