Published in IJCP November 2021
Case Report
Modified Tinea – A Mithering Problem
November 12, 2021 | Raj Kirit Ep, As Kumar
Dermatology
     


Abstract

Eberconazole has an anti-inflammatory effect and in our experience, also has a better role in managing steroid-modified and facial lesions. Eberconazole has a better role in clearance of the lesions. In these 5 cases of tinea infections, treatment with eberconazole helped in attaining favorable outcomes.

Keywords: Tinea, steroids, eberconazole

Tinea barbae and tinea incognito are increasingly becoming common due to the rampant misuse of steroid combinations. We herewith present 5 cases with history of using steroids on the affected areas.

Case 1

A 45-year-old male patient presented with multiple follicular papules to pustules over the beard region (Fig. 1) and had been treated as folliculitis by a general practitioner and he had approached us after failure of therapy. The lesion was itchy. As the patient was a sales executive and had to meet people, he had to shave daily which became very difficult for him.

Figure 1. Multiple follicular papules to pustules over the beard region.

He was diagnosed as tinea barbae and was started on capsule itraconazole 100 mg twice daily for 1 week and also on topical eberconazole. He responded after 3 weeks of therapy and got excellent response. His lesions disappeared by the end of 1 month, had no relapse after stopping the therapy.

Case 2

A 52-year-old male presented with boggy swelling on his moustache area (Fig. 2). He was prescribed a steroid combination of clobetasol, gentamicin and clotrimazole preparation by a general practitioner and had remissions on using these creams.

Figure 2. Boggy swelling over the moustache area.

Scrapings for potassium hydroxide (KOH) mount demonstrated hyphae and we started him on eberconazole. He responded at the end of 5th week. He had no relapse on follow-up until 4th month.

Case 3

A 35-year-old male had come to the Dermatology Department with complaints of itching, and papules on the back since 5 months. He had been going to many general practitioners who have been prescribing steroid combinations.

On examination, he had papules with crusts and at the edges, had ill-defined margins and few areas of central clearing were visible (Fig. 3).

Figure 3. Papules on the back.

A KOH mount was done which revealed hyphae. The patient was diagnosed with tinea corporis and prescribed tablet terbinafine 250 mg a day for 10 days and topical eberconazole.

He responded in 2 weeks and was asked to continue the topical therapy for 2 months for morphological clearance.

We did a repeat KOH mount and found no hyphae. Patient had no relapse after 6 months.

Case 4

A 19-year-old male, working in hotel industry, presented with itchy papules on the forearm. On initial examination, we presumed it to be polymorphous light eruption. But on closer inspection, we could elicit an ill-defined border over the wrist (Fig. 4).

Figure 4. Ill-defined border over the wrist.

On examination and probing the history, we found he had lesions all over the body for which he was applying “sapat malam”, a local quack preparation, and did not get any results.

He was started on tablet griseofulvin (as the patient could not afford) 250 mg every day for 2 months and eberconazole topically. He responded by the end of 3 months and had no relapse after 5 months.

Case 5

A 27-year-old male working as a driver had presented with itchy, scaly and diffuse patches over the face. He was treated as allergic contact dermatitis with systemic steroids.

On examination, he had a well-defined erythematous border on the face extending to the ears and back of the ears. KOH revealed fungal hyphae.

He was started on tablet terbinafine and eberconazole topically which led to significant improvement in the lesions.

Discussion

In all these 5 cases, we had started eberconazole topically. Though we had prescribed various oral antifungal therapies, we found local applications to augment the results for clinical clearance.

Eberconazole is a topical imidazole with a mode of action similar to that of other azole antifungals, which is, inhibition of fungal lanosterol 14α-demethylase.1,2

This drug is effective and has a good safety profile. The duration of therapy depends on the area involved.

References

  1. Fernández-Torres B, Inza I, Guarro J. In vitro activities of the new antifungal drug eberconazole and three other topical agents against 200 strains of dermatophytes. J Clin Microbiol. 2003;41(11):5209-11.
  2. del Palacio A, Ortiz FJ, Pérez A, Pazos C, Garau M, Font E. A double-blind randomized comparative trial: eberconazole 1% cream versus clotrimazole 1% cream twice daily in Candida and dermatophyte skin infections. Mycoses. 2001;44(5):173-80.