Last week, we brought to you an interesting case of a patient presenting with skin rash. The patient had tried multiple topical creams with steroids which only provided temporary relief. You gave us your evaluation of the case- diagnosis and appropriate treatment. In this part, Dr. Kiran Godse reveals the diagnosis and confirms the treatment method employed.

What is your diagnosis?

Most of the answers provided by the readers are correct. It is Tinea corporis,  but steroid modified. Central clearing with peripheral margin is seen in image 1 of the first part of the case study.

What treatment is appropriate?

1. As in this particular case, the patient has already tried steroid cream and terbinafine, he can be started on Cap. Itraconazole, 100 mg twice a day. The treating physician should ensure that the preferred Itraconazole should be of good quality and not a generic one.
2. For itching, Levocetirizine 5 mg may be prescribed at night.
3. For topical use, Luliconazole cream may also be advised at night time.
4. During day time, Clotrimazole dusting powder may be advised.
5. A complete blood count and blood sugar analysis is also advised to rule out anaemia and diabetes.

The treatment can be continued for one month to enable complete clearing. After this, powder and cream may be advised for another  15 days.

What are the general measures to be taken to control the infection?

The patient should be advised to wear cotton clothes. He should also be advised to wash clothes in hot water, as dettol alone does not kill fungus. The patient should also be told not to share any clothes and bathe twice a day.

Family members, if affected will need to be advised to take complete treatment. If a nail infection is seen, it needs three months of treatment.

This is a special, real-life case series in Dermatology. To view part of the case, click below,

Patient with skin rash: Tell us the diagnosis

Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.

The author, Dr Kiran Godse is a Professor of Dermatology.