University of Zagreb. School of Medicine. Chair of Dermatology.
Abstract
Tinea incognita je naziv za neprepoznatu dermatofitnu infekciju, izgled koje je bitno promijenjen uslijed neadekvatne i dugotrajne primjene kortikosteroidnih ili drugih neprimjerenih lokalnih pripravaka. Klinički, ove promjene imaju manje izražene rubove i manje se ljuskaju od „standardnih“ dermatofitoza. Pogrešna dijagnoza na samom početku liječenja, kao i „over-the-counter“ (OTC) pristup steroidima i drugim imunosupresivima u nekim zemljama doprinose činjenici da je incidencija tinea incognita veća nego ranije. Navedeni lijekovi suprimiraju normalan kožni imuni odgovor na dermatofite. Važno je da se, po postavljenoj dijagnozi, prekine terapija lokalnim steroidima. Površinske lezije odgovaraju terapijski povoljno na antimikotične kreme (npr. klotrimazol, mikonazol, ekonazol, oksikonazol, terbinafina). Opsežne lezije zahtijevaju i peroralnu antimikotičnu terapiju. Važna je, stoga, svijest o mogućnosti pojave dermatomikoze na licu kako bi se, na temelju rezultata mikološke obrade, postavila ispravna dijagnoza i spriječilo neadekvatno liječenje.Tinea incognita is a dermatophyte infection with atypical clinical features modified by the improper use of corticosteroids or other topical drugs as a result of dermatological misdiagnosis, having modified the clinical appearance of the fungal infection and transforming the typical ringworm infection and mimicking the other skin diseases. Clinically, these lesions have a less raised margin and are less scaly than common dermatophytosis. Over-the-counter (OTC) access to steroids and other immunosuppressants in some countries, as well as the increase in medications containing steroids, makes tinea incognita more likely, and therefore, the true diagnosis is frequently missed or delayed. These drugs suppress the normal cutaneous immune response to dermatophytes, thus enhancing the development of fungal superficial infections. It is, thus, important to discontinue the topical steroid treatment. Superficial lesions respond to antifungal creams (e.g. clotrimazole, miconazole, econazole, oxiconazole, terbinafine). Extensive lesions might sometimes require the oral antimycotictherapy, as well.The awareness of the possibility of the facial fungal infection is important in order to establish the proper diagnosis and to avoid the inappropriate treatment
