Please help, is this a fungus?

[optimus]

http://img396.imageshack.us/img396/4189/dsc00035uq.jpg

http://img136.imageshack.us/img136/4941/dsc00047mq.jpg

These pictures are of when it was at its worst, almost 2 months ago, it's improved slightly but still there.

I've seen my HMO doctor so far, and he thought it might've been sebhorriac(sp?) dermatitis, prescribed me some sufacet-r which made it worse, then I tried a natural rememdy using apple cider vinegar with mother, it scabbed up and the scabs fell off eventually but it never went away underneath apparently.  Then I tried putting on lotrimin af for about 2 weeks, and it's still there but in sligthly better condition, so I finally got a referral to a dermatologist and he said it's probably just some "irritation" and gave me some topical cream containing cortisteroids, but to not use it for more than 10 days.  Well, I used it for 10 days and it's still not healed and this morning it was getting redder.  What the heck is this?

[Alan Rockoff, MD]

It's unlikely to be fungus.  Perhaps it's irritation that the cortisone cream has helped but left some redness behind that hasn't had time to fade yet.  I suggest you call your dermatologist to tell him what's up.  He may want to see you again to perform a culture, or he may just want to prescribe a different cream.  If there is anything that rubs against your skin in these areas (I can't think of anything myself), try avoiding it.

Take care.

Dr. Rockoff

[optimus]

Dr, those pics were taken before I had begun any treatment.  The rash appeared out of the blue, and got worse over a period of about a week.  I've had it now for over 2 months.

What does it look like to you?  Have you ever seen anything like that before?

[Alan Rockoff, MD]

Thanks for the additional information, but it doesn't change my recommendation.  The rash needs to be re-examined, and tests performed if needed.  It looks like irritation, but it isn't acting like it, at least from what I can tell from your description.  You'll therefore need to ask your doctor in person.

Dr. Rockoff

[arbindo]

This is puzzling. The rash is described as a scaly annular rash with an erythematous border. looked at in isolation a dermatophyte(fungal) infection appears possible but the rash is symmetrical which makes this unlikely. Chronic cutaneous lupus erythematosus (DLE)comes to mind. Sorry to bring in such skin conditions but I am trying to think independently and look at it from all angles. DLE is scaly, may cause scarring later if untreated but treatment is possible once diagnosis is confirmed.
However this is usually not symmetrical in distribution. Needs a biopsy and potassium hydroxide preparation to exclude fungus.See a dermatologist.