Tinea Faciei in a Dress of Cutaneous Lupus Erythematosus

Tinea faciei (TF) is a type of superficial dermatophyte infection affecting the glabrous skin of the face (excluding the beard and moustache area in men). It can mimic several other dermatoses which involve the face and pose a diagnostic challenge [1]. Among fungal infections affecting the skin, TF is the most frequently misdiagnosed condition due to its variable morphological presentation. Approximately, 70% of patients having TF are wrongly diagnosed with other dermatoses [2, 3]. In this article, the case of TF simulating cutaneous lupus erythematosus is presented; wet mount and fungal culture enabled correct diagnosis and treatment, and avoided any unnecessary investigatory work up.
A 30-year-old male with itchy skin lesions in a typical butterfly pattern over the face of 1 month duration, was referred to our dermatology clinic by a general physician with a provisional diagnosis of cutaneous lupus erythematosus. There was a history of photosensitivity. He denied any history of treatment (topical or oral) before or after the appearance of lesions. Clinical examination revealed a large erythematous scaly plaque covering the nose and both cheeks in a typical butterfly distribution (figs. 1 A–C). The erythematous plaque had a well-defined raised erythematous border with central clearing. The rest of the dermatological examination including mucosae, nails and hair was non-contributory. A thorough review of systems was unremarkable. 10% potassium hydroxide (KOH) wet mount from the scrapings of the affected skin revealed fungal hyphae (fig. 1 D). Fungal culture from the skin scrapings taken from the edge of the plaque confirmed Trichophyton rubrum species establishing the diagnosis of tinea faciei. He was treated with itraconazole 200 mg/day along with topical Luliconazole cream to be applied twice a day. At 4 weeks’ follow-up, there was complete clearance of the lesions.
Tinea faciei can simulate several dermatoses including rosacea, cutaneous lupus erythematosus, polymorphous light eruption, allergic contact dermatitis, actinic keratosis, lymphocytic infiltrate of Jessner, psoriasis, impetigo, granuloma faciale, seborrheic dermatitis, granuloma annulare, among others [1, 3, 4]. Table 1 presents characteristic features of these entities. Trichophyton rubrum and Trichophyton mentagrophytes are the most common dermatophytes involved in the etiology of tinea faciei [5, 6]. Like cutaneous lupus erythematosus (CLE), the...


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