‘Tinea indecisiva’ may mimic the concentric rings of tinea imbricata

We describe an unusual clinical presentation of tinea corporis in two patients due to Trichophyton mentagrophytes var. mentagrophytes (patient 1) and T. tonsurans (patient 2). Both patients had seen multiple doctors and had used various prescribed topical corticosteroids and antifungals for several months because of indecision about the aetiology of the rash and its correct treatment. The rash consisted of widespread annular concentric erythematous rings on the arms (Fig. 1a), legs (Fig. 1b) and trunk of patient 1 and on the legs of patient 2 (Fig. 1c). This dramatic clinical picture has been described in tinea imbricata due to T. concentricum, which is confined to endemic areas and is associated with negative delayed-type hypersensitivity to T. concentricum. Long-term cyclical therapy with topical antifungals and corticosteroids may produce signs that mimic the characteristic clinical picture of tinea imbricata due to similar underlying mechanisms of immunosuppression with topical corticosteroids and reinfection due to early discontinuation of topical antifungals.