Diagnosis for skin rash - tinea incognito?

[aidenc]

I am 44yrs. I stopped using hydrocortisones on 9/20/08 after years (6-7) of use by spot treating my face or spots on my leg or arms, I can't remember what actually started it all now.  The only medication that I take is simvastatin 40mg daily and cholesterol is being maintained.

In 10/2007, I saw a dermatologist and showed him my face and wrist area and a few spots on my thigh.  No biopsies or skin scraping was done.  He gave me 10 days of ketoconazole 200mg and my face cleared within 3 days.  I was given fluticasone propionate .05% cream for the area on my thigh and wrist.  This cream was another corticosteroid which I was wanting to get off of.  Perhaps I should have been on a cream fungi maint after the oral?

I recently have seen a different dermatologist who suspected that I was allergic to the lotions I was applying.  I was given a patch test with results of cobalt chloride, disperse yellow 3 and narcissus absolute.  I am trying to remain aware to stay away from any of these components.  An ANA test was done to rule out lupus and it was negative.  A biopsy was done on 9/4, my first visit, and the results "indicate an allergic reaction" according to the doctor, I don't have a copy of the lab report to state further, and no medical terms of findings of the lab result were spoken to me.  This dermatologist's plan is to use Vanicream for moisturizing on my entire body along with Free and Clear shampoo which is very agreeable to my skin.  On 9/20, we planned to go cold turkey off of the hydrocortisones and follow up in 2 months.  The areas that I was treating/masking with the hydros has been free to run wild.  I have taken some pics to show.  The areas are itchy.  Please tell me what this could be.  I read that tinea incognito could mask a clinical representation or biopsy if done while using hydrocortisones which I was when my biopsy was taken.  Should I take another round of orals?

Pics: http://s405.photobucket.com/albums/pp133/mypalmtrees/

[aidenc]

Thanks, will post back.

[Alan Rockoff, MD]

I don't know what you have.  I can't correlate the success you say you had with oral ketoconazole in 2007 with what you are showing me now.  Tinea might be possible, but the biopsy didn't show it.  I think you ought to contact your dermatologist about doing a scraping and/or biopsy of the red spots in the pictures.  It may turn out that you just have dermatitis, or eczema, which is not a specific allergy to anything and which can only be treated by regular use of a topical steroid.  Once fungus is ruled out--and I think it will be--that may be your best option.  But you need to follow this up in person, not on the internet.

Best.

Dr. Rockoff