Ongoing ringworm

I had what I suspected was ringworm and used over the counter Lamisil.  After approximately 10 days, I didn't notice any improvement and went to the dermatologist.  He told me he did not think it was ringworm and did a scraping.  He told me to discontinue the Lamisil and prescribed a strong steroid cream to apply for 2 weeks.  I returned to see him in two weeks and was told it was NOT ringworm.  Even though the rash was not gone, he said to continue applying the steroid cream.  For several reasons, I began questioning the competency of this dermatologist and found a new one.

I sought out a second opinion for this "rash" with a new dermatologist.  She told me to discontinue using anything on the rash and she did a shave biopsy of the area.  After one week she called and said it WAS ringworm!  She prescribed econazole nitrate and told me to come back to see her in two weeks.  It had improved a bit, but not enough, so she prescribed Oxistat which I have been using twice a day for three weeks now.  It has improved a little and it is a small area, about the size of a dime.  The concern I have is there is this one little "pimple" that keeps coming and going in the same area.  It gets red and a bit raised and then after a few days it goes flat and goes to a slight pink color.  It has continued this cycle several times.  It also seems that at certain times of the day, the color of the rash can be more red than other times of the day.

I have an appointment to return to the dermatologist in a week and I will have been using the Oxistat for four weeks at that time.  Unfortunately, the dermatologist is a bit reluctant to use an oral antifungal because I have an intestinal disease, Crohn's disease.  Before trying the oral antifungal, is there another type of prescription (cream form) that I can use before trying the oral medication?  I am really afraid of taking the oral antifugal as this may really affect my Crohn's disease.

Thank you

[Bhupinder Kaur, MD]

Hello,
Various reasons for recurrent or persistent fungal infection are incomplete treatment, treatment resistance , co-existing dermatitis, diabetes and low immunity. Treatment resistance can be overcome by applying a cream with a combination of antifungals (Clotrimazole 1%, Miconazole nitrate 2%, Tolnaftate 1% and Butenafine hydrochloride 1%).

You can discuss about the combination therapy with your dermatologist.

It is very difficult to precisely confirm a diagnosis without examination and investigations and the answer is based on the medical information provided. For exact diagnosis, you are requested to consult your doctor. I sincerely hope that helps. Take care and please do keep me posted on how you are doing.