Ring like skin infection

[trayza]

Dear Doctor

Since January, I have had a rash on my right hand shoulder. The rash started off really small. The rash was really dry, raised round patch that is red and feels itchy. As patch got larger with time. The outer edge is scaly and red, but the inner area got paler again, like my own skin colour and looks to be healthy. If I rub it some of the flakes would come of.

I am still young and not sexually active. I have seen my doctor about the rash, he said that its looks like a ringworm which is a fungal infection. So I have been going in and out of the doctor trying different medicines each month.
The medicines I have used are, Clotrimazole, Ketocnazole, Terbinafine and oral Terbinafine. The medicine didn’t work so I was sent to the hospital to the dermatology department, they took a scrape test to see if it is a fungal infection. The doctor there had prescribed me with Canesten HC, which contains Clotrimazole and Hydrocortisone, just to use on the red raised patch around. I am using this medicine but can not see any improvements. The results for my scrape test came out that it is not any kind of fungal infection. Now I would be having a biopsy. The rash has covered my right shoulder and my collarbone spreading towards my chest but the rash has even spread to many parts of ma body, on my left shoulder few on my chest and inner thighs.

I am really worried and got a life ahead of me, it would be really helpful if you may give me some detail of what you think this skin infection can be or may be.
  
Thank You.  

[BhumikaMD]

Hi,


Ringworm can be mistaken for one of the following conditions: granuloma annulare, discoid lupus, and sarcoidosis.

Bullous tinea pedis (athlete foot with blisters) can mimic bullous drug reactions, bullous pemphigoid, and other bullous diseases of the skin.

Skin medication is usually successful at treating Ringworm within 4 weeks.

Advice often given to prevent ringworm includes:

* Avoidance of sharing clothing, sports equipment, towels, or sheets.
* Washing clothes in hot water with fungicidal soap after suspected exposure to ringworm.
* Avoidance of walking barefoot, wearing of appropriate protective shoes to the beach and flip-flops/thongs in locker rooms.
* After being exposed to places where the potential of being infected is great , washing with an antibacterial and anti-fungal soap or one that contains Tea Tree Oil, which contains terpinen-4-ol.

The treatment options include - Topical antifungal agents such as terbinafine 1% cream (Lamasil) applied twice daily until symptoms resolve (usually 1-2 weeks). Terbinifine is not recommended for children < 2 years old or anyone with impaired hepatic function.

Systemically with oral medications, especially for scalp ring worm, or infection of the finger nails or toe nails.

Call your doctor if:
    * Ringworm infects your scalp or beard.
    * His skin does not improve after 4 weeks of self-care.

If suspected ringworm does not respond to routine antifungal treatment, further diagnostics must be performed, like a skin biopsy, a fungal culture, or a skin scraping for fungus identification.

Let us know if you need any further information.

It would be advisable to consult a skin specialist for the symptoms and a proper clinical examination.

Let us know if you need any other information and post us on how you are doing.

Regards.