This man in his early 70s presented with a two year history of an itchy rash on his lower limbs. He had initially had a diagnosis of psoriasis and was treated with topical clobetasol propionate. Although the itch improved with this treatment, the rash persisted and worsened. On examination, there was clearly demarcated erythema on both feet and lower legs, and thickening, deformation, and discoloration of the toenails (fig 1). Fungal cultures of the skin identified Trichophyton rubrum, and the diagnosis was revised to tinea incognito with onychomycosis.bmj;389/apr03_7/e082105/F1F1f1Fig 1Tinea incognito refers to a superficial dermatophyte infection that has been inappropriately treated with topical steroids, leading to an atypical clinical appearance.1 This patient was treated with itraconazole (200 mg twice a day for seven days each month) orally for six months, and topical antifungal cream twice a day for one month, with substantial clinical improvement. This case highlights that tinea incognito…
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Clearly demarcated erythematous rash
