Background: Tinea faciei is a superficial dermatophyte infection of the face that commonly presents as an annular erythematous scaly lesion with active margins and central clearing. However, atypical presentations are increasingly encountered due to inappropriate topical steroid use, over-the-counter medication, cosmetic application, and delayed diagnosis. Such altered morphology may mimic eczema, seborrheic dermatitis, rosacea, acneiform eruptions, photosensitive dermatoses, or lupus-like lesions, making clinical recognition difficult.

Aim: The aim of the study was to assess the atypical presentation of tinea faciei and its occurrence across different age groups among patients attending a tertiary care hospital.

Material and Methods: A hospital-based observational study was conducted among 60 patients clinically diagnosed with tinea faciei at a tertiary care hospital & private clinic. Patients of all age groups and both sexes were included. Detailed history regarding demographic profile, duration of disease, symptoms, recurrence, topical steroid use, over-the-counter medication, cosmetic use, family history, contact history, and associated dermatophytosis was recorded. Clinical examination assessed site, number, morphology, scaling, erythema, pigmentation, papules, pustules, and extent of facial involvement. Skin scrapings were examined by potassium hydroxide mount. Data were analyzed using SPSS version 27.0. Frequencies, percentages, Chi-square test, and Fisher’s exact test were applied, with p<0.05 considered statistically significant.

Results: Among 60 patients, atypical presentation was observed in 41 patients (68.33%), while classical annular scaly lesions were seen in 19 patients (31.67%). The highest proportion belonged to the 21–40 years age group (36.67%), followed by 41–60 years (21.67%). Males constituted 56.67% and females 43.33%. Atypical presentation was most frequent among patients aged >60 years (80.00%), followed by 21–40 years (72.73%), though age-wise association was not significant (p=0.777). Steroid-modified or ill-defined erythematous plaques were the most common atypical pattern (26.67%). Visible scaling was significantly more common in classical lesions (p=0.025), whereas pigmentary changes were significantly associated with atypical lesions (p=0.022). Topical steroid use (p=0.001) and over-the-counter medication use (p=0.020) were significantly associated with atypical presentation. KOH mount was positive in 80.00% of patients.

Conclusion: Atypical tinea faciei was more common than classical presentation across all age groups. Steroid misuse and over-the-counter medication were major associated factors. Careful clinical assessment with KOH confirmation is essential for early diagnosis and appropriate treatment.