Abstract
A 53-year-old man presented with a rash on the right medial thigh that had been present for 2 years. During that time, he had been treated successively with desoximetasone 0.05% cream, augmented betamethasone dipropionate0.05% cream, and betamethasone/clotrimazole cream. The rash transiently improved with use of these medications but flared with any attempt to discontinue treatment. Physical examination revealed a 5-cm diameter, erythematous, atrophic patch with telangiectasis. No scaling was visible (figure 1). A potassium hydroxide preparation with Swartz-Lamkins stain revealed branching, septate hyphae, confirming the diagnosis of tinea incognito (figures 2 and 3). Topical butenafine hydrochloride cream applied twice a day and pramoxine hydrochloride lotion, a topical anesthetic, were prescribed. Topical steroids were discontinued. The patient reported flaring of redness and pruritus for I week after treatment was initiated and steady improvement thereafter. All treatment was discontinued after 3 weeks, and there was no recurrence of the rash.
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