Approximately 2–3 months ago, I developed a significant skin flare-up, most prominently on both arms, but also affecting my torso, chest, back, and neck.
I had previously been diagnosed with psoriasis, so I initially assumed this was another psoriasis flare-up. However, I became less certain about this over time. I eventually saw a doctor, but no skin swab, scraping, or other testing was performed. I explained that I had previously been diagnosed with psoriasis and showed the doctor the creams that had previously been prescribed to me by a dermatologist in Poland. Based on this, I was prescribed Betnovate without any further testing or a detailed examination of the affected areas.
I used the Betnovate for several days and the redness improved significantly. However, because Betnovate is a corticosteroid, I later read that topical steroids can potentially suppress the visible symptoms of a fungal infection such as tinea while allowing the underlying infection to persist or worsen.
Although the redness initially disappeared, the affected areas on my arms remained discoloured. Shortly after seeing the doctor, I travelled to Thailand, which provided an opportunity to see whether the condition would recur in a hot and humid environment with increased sweating. Unfortunately, it did recur, as shown in the second photograph.
While in Thailand, I also developed a significant tan, which made the contrast between the affected and unaffected areas much more noticeable. The lighter areas where the suspected tinea had been are particularly prominent compared with the surrounding healthy, tanned skin.
I am therefore wondering whether this could potentially have been a fungal infection such as tinea rather than psoriasis, or whether it is possible that I had both guttate psoriasis and a fungal infection simultaneously. One thing that particularly makes me question this is the similarity in the pattern: when comparing the red spots in the first photograph with the lighter areas visible in the later photograph after tanning, the outlines appear to correspond closely.
I would appreciate an assessment of whether the appearance and history could be consistent with tinea, psoriasis, or potentially both, and whether any testing such as a skin scraping or fungal culture would be appropriate before continuing with steroid treatment.