How can I tell if this is a fungus?

[Alessandro]

Dear Doctor,
  Please hear my long, strange tale...
  While growing up, I can remember a few quick bouts with mild eczema, but nothing continuous and it has always been localized.
  Two years ago, I went to China with a friend, and in a rather unsanitary spa, I developed a slowly growing eczema-like rash starting in the creases of my arms, spreading to my body and face within the course of a week. Upon my return, I was diagnosed with "a fungus" and was given diprosone as well as clotrimazole and i believe a betamethasone.
The creams eradicated the fungus, or so i thought. A month later, a small red patch reappeared on the crease of my arm- identical to its predeccesor, the fungus. Again, I was travelling, and, being in Europe I was able to get some Diprosone over the counter, (not the other creams) and spent then next year and a half self treating these recurring flare ups of redness. As you know, Diprosone is a very strong steroid and the next time I saw a dermatologist, I was warned not to use it anymore. At first glance, i was told i was dealing with eczema, but I have a suspicion that I have been merely muting the fungus that has remained on my skin for these years with the Diprosone.
In the last few months, I had a sudden, inexplicable flare up of roundish red spots, much more widespread than anything I had experienced in my childhood.  The spots were slightly elevated and moderately itchy all over my body, from feet, up the back and sides of my legs, flanks, armpits, shoulders- and cheeks. Horrified, I went to yet another dermatologist who prescribed a mild steroid. This steroid had little effect, only very temporary relief. After a month of regular steroid application with no effect, I just decided to let things be and part of the irritation cleared itself. I am awaiting a fungus test result, but that is weeks away and in the meantime, perhaps you could give your opinion. i have heard so many varying definitions of what a fungus can be and of course, I am hoping that it is a fungus so that it can actually be definitively treated. It has lodged itself particularily on two patches on my wrists, as well as a patch on my thumb, back of the knees and ankle creases and buttocks. From there, it will wax and wane somewhat, even without steroids, suggesting eczema. But though it can look less inflamed, it doesn't entirely go away- Essentially, is there any way i can find out right away that it is or is NOT a fungus or is the culture test the only way to tell? Can a fungus remain on the skin and come and go, or does it only get worse? I have an old pair of shoes that , every time I put on cause an immediate flare up (I have since thrown them away) Could it be that there are fungal spores in the shoes that reactivate the fungus on my skin?
as you can see, i am rather caught up with trying to figure this out...i am very worried about having to fight a lifelong battle with what  could just be an worsening condition of eczema..
thank you,
alessandro

[icculus]

Hi--about 2 years ago I noticed a small circle on my neck, then on my breast, and arm but they started to enlarge over time.  I used every over the counter fungus spray/cream I could find.  I also saw a doctor and was givin a cream (mentax) and pills (ketoconozole--I think that's what they were called).  The treatment of both cream and pills only minimized the red circles but did not resolve the issue.  I finally went to a dermatologist and a biopsy was taken and there were no sign of fungi.  All they could tell me was that it was some type of irritation.  I left it alone and it went away.  But now it's back--2 months later.  Today I heard of eczema and if any one could fill me in on this occurance I would greatly appreciate it.  Also, could it be possible that it was a fungus but all the treatments irritated my skin and by the time the doctor took the scrape it would have been gone from that region but had existed some where else on my skin?  Any help would be great.  I'm really confused about the situation and would like to know what's going on with my body!

[Alan Rockoff, MD]

I think you have eczema, which behaves exactly as you describe--steroid creams knock it down, but it comes back here and there, now and then.  Steroids like the ones you used would not have made a fungus go away, even temporarily--they would have made the rash worse and worse.  I therefore think there is no chance this is a fungus.  I think your dermatologists don't either, or they wouldn't have prescribed a steroid.  Eczema is lifelong, but it isn't present all the time, and is not progressively worse as you get older.  It just goes through ups and downs.

Please ask your dermatologist for clarification of these matters.

Best.

Dr. Rockoff