Recurrent tinea corporis inf, now resistant to azoles!

Hello all,

I'm a 27 yr old immunocompetent male. I have a history of recurrent tinea corporis infections (around the neck and shoulders), usually treated with topical azoles. Once, I had an extensive infection which I had to use itraconazole to treat. I always got great results with azoles.

For more than 2 months now, I've had a rash resistant to topical azoles. Rashes increasing in size and new ringworm rashes appearing.
I started a weekly dose of fluconazole (200mg/wk in addition to the topical azole I'm using), this is the 3rd week now, no improvement whatsoever!

2 dermatologists I went to, refused to run a culture & sensitivity test!
What do I do?

Should I add Terbinafine to the regimen, combine it with the others, stop the others, add any other meds, change the meds, take the fluconazole on a daily basis, change the doses.

I'm open to answering any questions also.
Please help!

[Bhupinder Kaur, MD]

Hello,
If you are immunocompetent then you should take Fluconazole only after a dermatolgist’s prescription. Your immune system can also be responsible for the resistant fungal infection. Before taking terbenafine consult a doctor. It is always best to take it under a dermatologist’s guidance as it is not without side effects.

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. Treatment can be started only when the diagnosis is confirmed. I sincerely hope that helps. Take care and please do keep me posted on how you are doing.