Successful Management of Psoriasis and Treatment-induced Tinea Incognito: A Case Report

This case report describes the management of a 64-year-old Hispanic male patient with a 20-year history of severe psoriasis who presented with a worsening of his condition, and topical corticosteroid-induced tinea incognito. The patient was initially treated with systemic and topical antifungals to clear the corticosteroid-induced tinea incognito. He was subsequently treated with broadalumab, an interleukin-17 receptor A antagonist. A combination of oral terbinafine and twice daily ciclopirlox cream to the pruritic lichenified patches on the patient's neck, upper chest, buttocks, and hip cleared the fungal tinea infection within one month, but well-demarcated plaques remained unchanged on nearly 35 percent of his body. Three weeks of after commencement of broadalumab, the pruritus resolved and the patient's psoriasis body surface involvement was less than three percent; at four months, it was less than one percent. Conclusion: PAs and NPs working in dermatology should monitor patients on long-term topical corticosteroid therapy to alert them to possible cutaneous complications. Tinea incognito and psoriasis often mimic each other and can occur concomitantly but require different treatment approaches. If tinea incognito is confirmed, topical corticosteroids should be discontinued and it should be treated with antifungals, while, if appropriate, systemic management of the psoriasis with an appropriate biologic may be initiated.