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LETTER TO EDITOR
Year : 2010  |  Volume : 4  |  Issue : 1  |  Page : 32-33

Lupus erythematosus like tinea of the face (tinea faciale)


1 Department of Dermatology, Venereology & Leprology, Gian Sagar Medical College, Ram Nagar Banur, Patiala - 140 601, Chandigarh, India
2 National Institute of Nursing Education, PGIMER, Chandigarh, India

Date of Web Publication17-Dec-2010

Correspondence Address:
Varinder Singh
Department of Dermatology, Venereology & Leprology, Gian Sagar Medical College, Ram Nagar Banur, Patiala - 140 601
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0331-3131.73884

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How to cite this article:
Singh V, Narang T, Narang K. Lupus erythematosus like tinea of the face (tinea faciale). Ann Nigerian Med 2010;4:32-3

How to cite this URL:
Singh V, Narang T, Narang K. Lupus erythematosus like tinea of the face (tinea faciale). Ann Nigerian Med [serial online] 2010 [cited 2020 Nov 26];4:32-3. Available from: https://www.anmjournal.com/text.asp?2010/4/1/32/73884

Sir,

Tinea faciei in a majority of cases is frequently misdiagnosed due to its variable appearance. As many as 70% of the patients with tinea faciei are initially misdiagnosed as having some other dermatoses such as cutaneous lupus erythematosus, rosacea, and granuloma annulare. We present a similar case that was being diagnosed and treated as lupus erythematosus.

A 34-year-old female presented with itchy erythematous plaques over her face since 5 months. She also had associated symptoms of photosensitivity. She was diagnosed as having the malar rash of lupus erythematosus and advised sunscreen, topical steroid cream and tablet hydroxychloroquine. The rash subsided temporarily, however recurred within 2 days of stopping topical steroid. At this first presentation to us, she had confluent erythematous plaques on the malar area of face with involvement of the eyebrows and annular scaly plaques on the mandibular area [Figure 1]. Results of a potassium hydroxide preparation and culture from the surface scales confirmed the clinical diagnosis of tinea faciale. Complete resolution was accomplished with tablet terbinafine 250 mg orally once daily for 2 weeks.
Figure 1 :Confluent erythematous plaques on the malar area of face of the patient

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Tinea faciei in a majority of cases is frequently misdiagnosed due to its variable appearance. As many as 70% of the patients with tinea faciei are initially misdiagnosed as having some other dermatoses such as cutaneous lupus erythematosus, [1] rosacea, [2] and granuloma annulare. [3]

Atypical features are more common in tinea faciei than in other forms of ringworm, possibly due to the complex anatomy of the face. There is a broad range in size, degree of inflammation, and depth of invasion. Tinea faciei most often begins as flat, scaly macules that develop a raised border that may advance outward in all directions, and may or may not develop papules, vesicles, and crusts. The central area becomes hypopigmented or brown and less scaly as this occurs. [4]

Most cases of tinea faciei are superficial, and can be easily treated with topical antifungals. Resistant strains, extensive disease, and multiple plaques may require oral antifungal therapy.

Tinea can be added to the list of infectious agents that have a photosensitivity component. The fungus possibly "photolocalizes" to sun-damaged areas, i.e., areas of increased capillary permeability. This case illustrates the importance of including tinea in considering differential diagnoses of LE like lesions on the face. [4]

 
   References Top

1.Meymandi S, Wiseman MC, Crawford RI. Tinea faciei mimicking cutaneous lupus erythematosus: a histopathologic case report. J Am Acad Dermatol 2003;48:S7-8.   Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2.Lee SJ, Choi HJ, Hann SK. Rosacea-like tinea faciei. Int J Dermatol 1999;38:479-80.  Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.Baxter DL, Moschella SL, Johnson BL. Tinea of the face. Arch Dermatol 1965;91:184-5.   Back to cited text no. 3
    
4.Alteras I, Sandbank M, David M, Segal R. 15-year survey of tinea faciei in the adult. Dermatologica 1988;177:65-9.  Back to cited text no. 4
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