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E-IJD® - CORRESPONDENCE
Year : 2021  |  Volume : 66  |  Issue : 4  |  Page : 448
Unmasking Facial Tinea in the COVID-19 Era


1 Consultant Dermatologist, Abrahams Skin and Hair Clinic, 12, 14th Main, Vasanth Nagar, Bangalore, Karnataka, India
2 Medical Director and Senior Consultant Dermatologist, Amanza Skin Clinic, Perinthalmanna, Kerala, India

Date of Web Publication17-Sep-2021

Correspondence Address:
Karalikkattil T Ashique
Medical Director and Senior Consultant Dermatologist, Amanza Skin Clinic, Perinthalmanna, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.ijd_989_20

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How to cite this article:
Abraham A, Ashique KT. Unmasking Facial Tinea in the COVID-19 Era. Indian J Dermatol 2021;66:448

How to cite this URL:
Abraham A, Ashique KT. Unmasking Facial Tinea in the COVID-19 Era. Indian J Dermatol [serial online] 2021 [cited 2021 Dec 2];66:448. Available from: https://www.e-ijd.org/text.asp?2021/66/4/448/326151




Complete examination of the skin has been the norm in dermatology. The onset of the COVID-19 pandemic has created a paradigm shift in clinical practice. Both examining physician and patient are often wearing a face mask and maintaining a 'safe distance'.[1] This 'new normal' could result in less than ideal complete cutaneous examination.

This case highlights two aspects related to this phenomenon. (a) Incomplete examination especially of the face, especially beneath the mask, could lead to a missed diagnosis of tinea faciei. (b) Prolonged use of face masks could potentially create an area of occlusion, heat, and sweating in a tropical climate leading to an unusual presentation of tinea.

There have been reports of various dermatological issues related to COVID-19.[2],[3] This patient who has been wearing a mask for many hours daily presented with tinea elsewhere on his body. He, however, did not complain of any lesions or discomfort on the face. Having seen many such "veiled tinea" in recent times, we asked him to remove the mask and found that he did have subtle lesions on the face in the area covered by the mask, which would have otherwise gone unnoticed and untreated [Figure 1]a and [Figure 1]b Such presentations are on the rise after masks became the new normal. This case highlights the fact that missing the obvious is more common in masked patients and the odd presentations of Tinea faciei need to be searched for in the COVID-19 setting. Also, we are of the opinion that the area under cover of the mask being more humid and occluded for prolonged time is a new locus for fungal infection like the groin. Hence, special attention needs to be paid to the examination and treatment of tinea especially on the face.
Figure 1: (a) Typical non-surgical mask worn by people which cover larger area and a good nidus for humidity and fungal colonization. (b) Subtle tinea lesions on the face which are often missed unless the mask is removed and examined

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   References Top

1.
Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public. [Last accessed on 2020 Jun 14].  Back to cited text no. 1
    
2.
Young S, Fernandez AP. Skin manifestations of COVID-19. Cleve Clin J Med 2020. doi: 10.3949/ccjm.87a.ccc031. Online ahead of print.  Back to cited text no. 2
    
3.
Wollina U. Challenges of COVID-19 pandemic for dermatology. Dermatol Ther 2020;33:e13430.  Back to cited text no. 3
    


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