Tinea incognito and "over-the-counter" potent topical steroids.

The term tinea incognito has been used to describe a dermatophyte infection modified by corticosteroid treatment. Lesions are often atypical appearing and the diagnosis is frequently delayed or missed. This difficulty is often exacerbated by the random misuse of potent dermatologic preparations that can alter the initial presentation to the dermatologist. Recently, we have encountered an increasing number of patients who have obtained potent superpotent topical steroids "over the counter" to self-treat various dermatoses. We report two such cases of tinea incognito that were exacerbated and altered clinically by the use of such preparations.

Treatment of porokeratosis of Mibelli with CO2 laser vaporization versus surgical excision with split-thickness skin graft. A comparison.

BACKGROUND: Porokeratosis of Mibelli has been treated with many topical surgical modalities in the past, including cold steel surgical excision and CO2 laser excision. We report a patient with an 8 x 10 cm2 plaque of porokeratosis on the dorsum of his hand, fingers, and web spaces. OBJECTIVE: To compare the treatment results of CO2 laser vaporization versus cold steel surgical excision with split-thickness skin graft placement. METHOD: The portions of the lesion overlying the metacarpophalangeal joints, fingers, and web spaces were treated with CO2 laser vaporization. The remainder of the lesion covering the dorsum of the hand was excised with cold steel, followed by placement of a split-thickness skin graft over that area. RESULTS: The portion of the porokeratosis lesion treated with CO2 vaporization healed with results cosmetically and functionally superior to the grafted area. CONCLUSION: Carbon dioxide laser vaporization, a more superficial treatment modality than CO2 laser excision, should be the preferred treatment modality for porokeratosis lesions.