What Is Causing This Patient's Worsening Rash After Topical Corticosteroid Use?

    July 2025 in “ JAAPA ”
    Cody A Sasek, Tannette Knox, Weilong Li
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    TLDR The rash worsened due to a fungal infection masked by corticosteroids.
    A 40-year-old male with atopic dermatitis experienced a worsening rash on his hand after using topical corticosteroids, initially thought to be atopic dermatitis. The rash, which became pustular and ecchymotic, was diagnosed as tinea incognito, a dermatophyte infection often misdiagnosed due to corticosteroid masking. Treatment with oral terbinafine and topical clotrimazole resolved the lesions. This case highlights the need to consider tinea incognito in patients with worsening skin conditions after corticosteroid use and to monitor antifungal treatments for adverse effects.
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