13/02/2026
Male 45 years old presented with these lesions over face for 7 days have been applying dermovate on the lesion.
Morphology of lesion
Annular plaques
Raised, erythematous, slightly scaly border
Central clearing
Located over nose and malar area
History of topical clobetasol (Dermovate) use × 5 days.
This morphology is very suggestive of Dermatophytosis of the face (Tinea faciei) — but now likely modified by steroid use.
Differentials
1. Discoid lupus erythematosus (DLE) – but usually has adherent scaling, dyspigmentation, follicular plugging
2. Seborrheic dermatitis – more diffuse, greasy scaling
3. Granuloma annulare – non-scaly, firm border
4. Cutaneous leishmaniasis (consider in endemic areas of Pakistan) – usually ulcerative or infiltrative plaque
5. Rosacea – lacks annular raised border
Given central clearing + raised border → fungal is most consistent.
Suggested Confirmation (if needed)
•KOH mount from active border
•Scrap from peripheral edge, not center
Management :
Stop steroids
For localized lesion:
• Terbinafine 1% cream BD × 2–4 weeks
OR
• Luliconazole 1% OD × 2 weeks
OR
• Sertaconazole BD
Apply:
• 1–2 cm beyond margin
• Continue 1 week after clinical clearance
Terbinafine 250 mg OD × 2–4 weeks
• Or Itraconazole 100 mg BD × 2 weeks
(LFT baseline if prolonged therapy)
Counseling
• Avoid steroid combinations
• Do not share towels
• Check for tinea corporis / cruris / family infection
Final Impression:
*Most consistent with Tinea faciei → now evolving into Tinea incognito due to clobetasol use*
