Tobi came in with four ring-shaped patches, each surrounded by spreading scaly borders. A steroid cream from the local store had made each one three times larger. Mascot Healthcare diagnosed tinea corporis and cleared all four with the correct antifungal.
Secondary school student, Yaba. Presented with four separate annular (ring-shaped) scaly patches on the trunk and upper arm, spreading over 6 weeks. Previously treated with a steroid cream by a patent medicine store — lesions expanded significantly after this.
Tinea Corporis (Ringworm)Tobi noticed the first ring on his back after a school sports trip. A friend said it was ringworm and told him to put "the orange cream" on it — a generic steroid-antibiotic combination cream sold at most patent medicine stores in Lagos. He applied it. The ring got bigger. He applied more. Three more rings appeared.
Six weeks later, he had four large ring-shaped patches and came to Mascot Healthcare with his mother. The lesions were enormous — each originally perhaps 2 cm, now 5–7 cm across. The borders were actively advancing and slightly raised.
The doctor looked at the pattern and took a skin scraping from the border of the largest lesion. KOH preparation under the microscope confirmed fungal hyphae. "The steroid cream suppressed the inflammation enough to hide the diagnosis — but stimulated fungal growth," the doctor explained.
Tinea corporis (ringworm) is a superficial fungal infection producing characteristic ring-shaped lesions with central clearing and scaly, advancing borders. Misdiagnosis leads to mismanagement — especially the dangerous use of steroid creams.
Annular lesions on the upper back, chest, right upper arm, and abdomen — each with a clear centre and scaly red border.
The leading edge of each ring was visibly wider and scalier than the inner cleared area.
Pruritus — especially at the border of each lesion; worse in heat and after exercise.
Each lesion had grown from approximately 2 cm to 5–7 cm after the steroid cream was applied — "tinea incognito."
No fever, no lymph nodes — purely cutaneous infection.
Generic steroid-antibiotic cream (betamethasone + gentamicin) × 6 weeks — steroids suppress the immune response that limits fungal spread, causing dramatic lesion enlargement ("tinea incognito").
Bathing with antiseptic soap — hygiene measure; no antifungal effect.
KOH preparation confirmed tinea corporis. Given the multiple large lesions and the failure of (incorrect) prior topical treatment, an oral medication was chosen, and a medicated cream was also applied to the borders of each lesion.
Tobi was advised: no steroid cream on any ring-shaped rash; wash towels and bedding; avoid sharing towels; do not scratch — it spreads the infection. The sports trip clothing was inspected — likely source was a shared towel or mat.
Tinea Corporis (ringworm) — KOH positive for fungal hyphae; tinea incognito (steroid-induced expansion)
A course of oral medication; a medicated cream to the lesions; hygiene education; no steroid cream
At 2 weeks: lesions visibly shrinking, itch resolved. At 4 weeks: all four lesions cleared, leaving mild post-inflammatory hyperpigmentation.
All four lesions cleared completely within 4 weeks of starting the correct antifungal treatment. The PIH is fading. No recurrence at 2-month check.
Tinea corporis (ringworm) is one of the most common mismanaged skin conditions in Nigeria. The combination steroid creams widely available over the counter dramatically worsen fungal infections by suppressing the immune response that limits fungal spread.
A ring-shaped rash that is growing after steroid cream application is tinea until proven otherwise.
Never put steroid cream on a ring-shaped rash. Ringworm needs antifungal — steroids make it multiply.
Book an appointment at Mascot Healthcare, Akoka — same-day slots often available, 4.9★ rated.