A Closer Look at the Term "Tinea Incognito:" A Factual as Well as Grammatical Inaccuracy.

Sir,

Ives and Marks coined the term tinea incognito in 1968 in their paper describing 14 patients who presented with unusual clinical presentations following application of topical corticosteroids (TCSs) for superficial dermatophytosis.[1] Since then, tinea incognito has been an accepted term and is also used interchangeably with the term “steroid-modified tinea.” Are these indeed synonyms or is there a tangible difference between the two?

Ives and Marks chose the term tinea incognito when they noticed the vitiation of lesions of dermatophytosis induced mostly by topical steroids at a time when the phenomenon was hitherto undescribed in dermatologic literature.[1] TCS was relatively young too at that time. Therefore, the term “tinea incognito” in that period and context was correct. However, many of us blindly continue to use the term despite the fact that all the features initially described by the authors as unusual and bizarre are now known to occur in tinea that has been modified by topical steroids, the latter too having evolved over a period of almost five decades. And therefore, most cases of tinea “incognito” are not “incognito!” What needs to be reiterated in this context is that topical steroids do modify the morphology of tinea to varying extent but do not necessarily make the disease difficult to recognize [Figure 1]. Therefore, a majority of them are better described as “steroid-modified tinea” rather than “tinea incognito.” Only a minority of presentations may be difficult to diagnose and therefore qualify to be called “tinea incognito,” a good example being lesions occurring on the face [Figure 2].

Figure 1

Tinea cruris et corporis merging into each other along with erythema, scaling, and striae due to long-term application of combination creams containing clobetasol propionate

Figure 2

Tinea faciei rendered difficult to diagnose because of the widespread erythema and scaling due to long-term application of combination creams containing clobetasol propionate

The other issue is the grammatical incorrectness of the term tinea incognito. It is surprising to note that a PubMed search on the term tinea incognito yielded 77 results, whereas there were only seven results for the term tinea incognita, despite the fact that the latter is the grammatically correct term! The Latin noun “Tinea” is feminine gender and therefore the adjective “incognito” that follows it should also be feminine gender, i.e., “incognita.” And therefore, the correct word is “Tinea incognita.” The grammatical error has been pointed out just once by Holubar and Male in 2002 but has been sadly ignored.[2] This is a humble attempt to exhort readers to use the correct term “tinea incognita” and that too only when lesions of tinea are rendered unrecognizable and not just modified as happens frequently with steroid abuse.

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Conflicts of interest

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