Circinate Type Impetigo Incognito

A 5-year-old child presented with bullous impetigo lesions on the trunk for 5 days. The mother had applied over-the-counter betamethasone cream, leading to the development of circinate lesions. A few vesicles around the circinate lesions showed a positive hypopyon sign [Figure 1]. Gram staining and bacterial culture confirmed Staphylococcus aureus. Based on culture sensitivity, the child was treated with oral cefadroxil, leading to resolution of lesions after 2 weeks.Figure 1: Circinate lesions at the site of topical betamethasone cream application. Several vesicles surround the impetigo incognito lesions, with a few showing the hypopyon signImpetigo, caused by S. aureus or group A β-hemolytic streptococci, is a common bacterial skin infection. The recent increase in over-the-counter topical corticosteroid (TCS) use has resulted in modified lesions known as impetigo incognito.[1] Studies suggest that TCS disrupts the stratum corneum, affecting lipid biosynthesis, increasing transepidermal water loss, and inducing pro-inflammatory cytokines such as tumor necrosis factor-α, interleukin (IL)-1, and IL-6. This process leads to inflammation and epidermal proliferation.[2] Thus, TCS application in impetigo can cause lesions to appear eczematous or circinate, causing diagnostic confusion. The differential diagnosis for the circinate pattern in impetigo incognito includes circinate impetigo, linear immunoglobulin A disease, erythema multiforme, and discoid eczema.[1] Declaration of consent The authors certify that they have obtained all appropriate consent forms, duly signed by the parent(s)/guardian(s) of the patient. In the form, the parent(s)/guardian(s) has/have given his/her/their consent for the images and other clinical information of their child to be reported in the journal. The parents understand that the names and initials of their child/children will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.