A 23-year-old male presented with a 4-week history of an itchy skin lesion affecting his right hand. Initial treatment with topical corticosteroids resulted in worsening and progressive centrifugal growth with blister formation.

Physical examination revealed the presence of an erythematous annular plaque with prominent peripheral blisters along with serous crusts and vesiculation in the central region (Fig. 1). The patient declared having come into contact with a guinea pig. Three years prior, he had a tattoo done right in the same region where the lesion appeared. No other systemic symptoms were elicited.

Figure 1

A fungal culture was performed and empirical treatment with oral terbinafine 250mg/day was initiated. The culture results confirmed the presence of Trichophyton mentagrophytes. After a 5-week regimen of treatment, the plaque was resolved.

Bullous tinea is a highly unusual variant of dermatophytosis, characterized by an intense inflammatory reaction. The hand is an exceptional site for its occurrence, appearing more commonly in the feet. Although tinea arising from recent tattoos has been reported, in our case it was probably just a coincidental finding, as the tattoo had been done 3 years prior to the lesion. Given the increasing number of cases with this condition, it is essential for clinicians to be aware of this uncommon type of presentation.