Dr Sirisha. MA, Dr Prashant Donkar
ABSTRACT:
Introduction:
Tinea incognito is an atypical presentation of dermatophytosis that inappropriate application of topical corticosteroids, which obscures the classic annular and scaly appearance, often resulting in diagnostic delay and prolonged infection.
Its atypical presentation often mimics inflammatory dermatoses such as eczema, psoriasis, or lichen simplex chronicus. This case report describes the clinical presentation, considerations, and individualized homoeopathic management of a patient with chronic tinea incognito.
KEYWORDS: Tinea Incognito, Homoeopathy, Sulphur, Individualized treatment, Case report.
Case Presentation:
A 24-year-old female presented with intensely pruritic circular lesions over the posterior aspect of the left shoulder for one year. The lesion began as a small annular plaque that gradually enlarged, with similar adjacent lesions developing over time. She reported temporary relief by the application of topical steroid-containing cream. Examination revealed a hyperpigmented lichenified plaque with central crusting and adjacent hyperpigmented papules. Based on the clinical history of steroid use, lesion morphology, and differential diagnosis, a diagnosis of tinea incognito (steroid modified tinea corporis) was made. Individualized homoeopathic case analysis using kentian evaluation and repertorization identified Sulphur as the indicated constitutional remedy.
Intervention and Outcome:
The patient received a single dose of Sulphur 200C, followed by placebo and regular follow-up. Within one month, pruritus was markedly reduced with improvement in sleep, mental and physical restlessness, and regression of skin lesions. And from first follow up patient reported complete resolution of pruritus, accompanied by marked regression of the cutaneous lesions. The Modified Naranjo Criteria for Homoeopathy (MONARCH) score was +7, indicating a major clinical improvement.
This case highlights the importance of recognizing steroid modified dermatophytosis and emphasizes the need to avoid indiscriminate topical corticosteroid use. The observed clinical improvement following individualized homoeopathic treatment warrants further systematic investigation through well designed controlled clinical studies to evaluate its role as a complementary approach in the management of chronic tinea incognito.
HISTORY OF PRESENT ILLNESS:
The patient developed a small itchy circular lesion over posterior aspect of left shoulder that gradually enlarged. Similarly, other lesions later appeared near to that lesion. There was no fever or systemic illness, And the patient was using a steroid containing cream with temporary improvement.
PAST HISTORY: The patient has no hypertension, no diabetes, no previous ringworm or no immunosuppressive disorders or major illness in past.
PERSONAL HISTORY:
| Appetite: Normal appetite. | Bowels: Once per day, satisfactory. |
| Desires: Sweets+++ | Urination: 4 – 5 times per day; 0 – 1 at night. |
| Aversions: Nothing specific. | Perspiration: More sweating over back. |
| Thirst: 2 – 3 Liter Per Day. | Sleep: Disturbed due to itching. |
| Thermals: Chilly patient. | Dreams: Nothing specific. |
LIFE SPACE INVESTIGATION:
As patient is a hostel resident, staying in girl’s hostel for the past 2 years at costal region, shares a room with 3 other roommates studying in same class, shares common bathrooms and washing machine among other hostel mates. Occasionally shares towel when her friends visit her room and overstay with her. She sweats more in back region, and it aggravates itching, and she feels more irritated and restless both physical and mentally.
FINAL NOSOLOGICAL DIAGNOSIS:
- Tinea incognito (steroid-modified tinea corporis).
EVALUATION OF SYMPTOMS: (as per Dr. J. T. Kent)
| Mental Generals | · Irritated during itching.
· Mental restlessness. |
| Physical Generals | · Physical restlessness.
· Sleep disturbed due to itching. · Excessive perspiration. · Desires sweets. · Chilly patient. |
| Particulars | · Itchy eruptions over posterior aspect of left shoulder.
· Perspiration < Itching. |
REPERTORIAL TOTALITY: (Synthesis TE2009)
- MIND – IRRITABILITY
- MIND – RESTLESSNESS
- SLEEP – SLEEPLESSNESS – itching; from
- GENERALS – RESTLESSNESS
- GENERALS – FOOD and DRINKS – sweets – desire
- GENERALS – HEAT – lack of vital heat
- EXTREMITIES – ERUPTIONS – Shoulders
- SKIN – ERUPTIONS – itching
- GENERALS – SIDE – left
- GENERALS – PERSPIRATION – during – agg.
REPERTORIAL RESULT:
- Sulphur 25/10
- Mercurius Solubilis 23/10
- Nux Vomica 20/10
RX,
Sulphur 200 1 Dose, early morning empty stomach.
MONARCH Scale:
The Modified Naranjo Criteria (MONARCH) was used to assess the causal relationship between the remedy and the clinical outcome.
| QUESTIONS | SCORE |
| 1. Was there an improvement in the main complaint? | +2 |
| 2. Was there an improvement in associated symptoms? | +2 |
| 3. Was there an initial homeopathic aggravation? | 0 |
| 4. Did the patient’s overall well-being improve? | +2 |
| 5. Direction of cure (Hering’s Law)? | +1 |
| Total Score | +7 (Major Improvement) |
CONCLUSION:
This article, case report shows the significance of an individualized homoeopathic treatment in management of chronic tinea incognito. The patient’s complete response with resolution of both local skin lesions and associated mental and physical generals, which highlights the holistic homoeopathic intervention, the prescribed remedy Sulphur based on the totality of symptoms was an effective in constitutional disturbances, leading to an improvement without any aggravation or any adverse effects. This case may provide clinical evidences supporting homoeopathy is a safe, effective for antifungal treatment, particularly in chronic, recurrent or risk of suppression and drug resistance.
CONFLICT OF INTEREST: None to declare.
FINANCIAL SUPPORT: Self-funded.
DECLARATION OF THE PATIENT CONSENT: Patient Consent has been taken for the images to be displayed in the article.
REFERENCES:
- Davidson’s Principles and Practice of Medicine. 24th ed. Edinburgh: Elsevier; 2022.
- Murgod SM, Shah K. A systemic review on efficacy of homoeopathic medicines in tinea infections (Ringworm). Int J Health Sci. 2022.
- Rook’s Textbook of Dermatology. 9th ed. Oxford: Wiley-Blackwell; 2016.
- Organon of Medicine. 6th ed. New Delhi: B. Jain Publishers; 1921.
- Dermatophytes: Update on Clinical Epidemiology and Treatment. 2024.
Sirisha. MA, Dr Prashant Donkar
Undergraduate Scholar, HOD and Guide, Department of practice of medicine including essential pharmacology, Alva’s Homoeopathic Medical College and Hospital, Moodbidri, Karnataka, India.
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