Similar or different? A case report of confusing coexistence of tinea and psoriasis

Abstract

Psoriasis is one of the most common dermatoses worldwide. It is a chronic, immunologically mediated, inflammatory disease associated with the polygenic predisposition and stimulated by environmental factors. The most characteristic skin lesions include well-demarcated, erythematous plaques with silvery-white scales. Psoriasis is often misdiagnosed with other skin conditions, particularly dermatitis and fungal infections. Their coexistence is also possible. We present a case of a 23-year-old patient with a history of recurrent skin lesions with accompanying mild pruritus. The first lesions were diagnosed as allergic dermatitis and successfully treated with topical steroids several times. Three years after the first episode, the exacerbation of skin lesions resistant to previous treatment occurred. The direct mycological examination was positive. Fungal cultures indicated Trichophyton verrucosum and Candida spp. The patient was treated systemically with terbinafine and topical ciclopirox olamine. Although clinical improvement was achieved after a few weeks, still partial activity with papules within the residual lesions remained. The performed skin biopsy ruled out fungal infection and pointed to psoriasis. The antipsoriatic treatment resulted in remission.