Is less diffuse distinct borders the only key dermoscopic feature of steroid modified tinea? A cross sectional observational study

Joe George; T.N Revathi

Is less diffuse distinct borders the only key dermoscopic feature of steroid modified tinea? A cross sectional observational study

Author(s)	Dr. Joe George, Dr. T.N Revathi
Country	India
Abstract	Background: Steroid-modified tinea (tinea incognito) is an increasingly common consequence of the rampant, unsupervised use of over-the-counter topical corticosteroid-antifungal-antibacterial combination creams in India. Its altered clinical morphology often confounds diagnosis. Existing dermoscopic literature has largely emphasised follicular and hair-shaft changes (comma hairs, morse-code hairs, translucent hairs) as the hallmark clue to steroid modification, but it is unclear how consistently these are found across an unselected clinical cohort. Aims and Objectives: To analyse the dermoscopic features of steroid-modified tinea in patients attending the dermatology outpatient department of a tertiary care centre, and to identify the most consistently observed feature. Materials and Methods: A hospital-based, descriptive, cross-sectional study was conducted over 18 months (May 2024-October 2025) at Sapthagiri Institute of Medical Sciences and Research Centre, Bengaluru. Patients aged 18-70 years with a clinically suspected diagnosis of steroid-modified tinea and a clear history of prior topical steroid application were evaluated using 10% potassium hydroxide (KOH) microscopy and polarized dermoscopy (ILLUCO IDS-1100). The single most striking dermoscopic feature of the representative lesion in each patient was recorded into one of six predefined categories. Results: Sixty patients with steroid-modified tinea were evaluated. Irregular, less-distinct diffuse borders were the most frequently recorded feature (23/60, 38.3%), followed by scattered/suppressed scaling (15/60, 25.0%), atrophy/striae (11/60, 18.3%), erythema (5/60, 8.3%), hair-shaft changes such as comma hairs, translucent hairs, broken hairs and black dots (4/60, 6.7%), and micropustules/pustules (2/60, 3.3%). Among patients in whom the source of the topical steroid was documented (n=40), the majority had procured it directly from a medical store without a prescription (24/40, 60.0%), followed by a general practitioner (13/40, 32.5%) and friends or family (3/40, 7.5%). Conclusion: Contrary to the emphasis placed on hair-shaft changes in earlier literature, these were the least frequent finding in our cohort. Loss of a well-defined, sharp lesion margin, appreciated dermoscopically as an irregular or diffuse border, was the only feature common enough across the cohort to be considered a reliable clue, and may serve as a simple, rapid pointer to topical steroid abuse even when the classical follicular stigmata are absent.
Keywords	Tinea incognito, steroid-modified tinea, dermoscopy, diffuse border, topical steroid abuse, dermatophytosis
Field	Medical / Pharmacy
Published In	Volume 8, Issue 4, July-August 2026
Published On	2026-08-14

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Is less diffuse distinct borders the only key dermoscopic feature of steroid modified tinea? A cross sectional observational study

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