Ringworm or Nummular Dermatites?

[mcon]

I have several rashes on my lower leg and forearm one of which is circular and about 3 inches in diameter.  I was just recently diagnosed with Nummular Dermatitis, (and prescribed Embeline E), by my Dermatologist.  This diagnosis replace an initial diagnosis of Ringworm a weak earlier  (prescribed Ketoconazole cream).  The initial diagnosis of Ringworm was made based on a KOH test by a Nurse Practitioner.  On visual examination only, the Dermatologist diagnosed Nummular Dermatitis and dismissed the Nurse Practitioner’s diagnosis– my concern is if the Dermatologist’s diagnosis is incorrect the steroid cream will mask the fungal infection and make everything a lot worse.  My symptoms have gotten a lot worse over the past few months where I infrequently applied over-the-counter hydrocortisone cream to stop the itching.  Should I take the Embeline for a few weeks to see what happens and if so is worth risking making a potential fungal infection worse?

[Alan Rockoff, MD]

The steroid will either clear you right up in a few days (confirming the nummular dermatitis diagnosis), or make the rash get much worse, also right away (if it's fungus.)  Nummular (meaning round) dermatitis is much more common than fungus ("ringworm", so the dermatologist is probably right.  But you don't need to worry about masking symptoms.  Your clinical improvement should clinch the matter.

Take care.

Dr. Rockoff

[maureen123]

My son has similar roundish red patches on his torso, mostly groin area and hips. One doctor did a scraping and the results came back as it not being fungle. So he received a steroid cream that stung and didn't work. So I got a second opinion and they said it was fungle and prescribed Lamasyl (sp?). This hasn't really worked either. The spots start out looking red and raised like exzema (eczema) then they spread out and clear up in the center and are only rough and flaky around the rim. I'm at my whits end trying to figure out what to do for him. Could this be ringworm? How do you get it?

[seekanswer]

I had the exact same symptom described by the previous patient. Worse, I had the rash for over 5 years. I have seen several dermatorgist and I felt none can give correct diagnosis. Are they all incompetent or is this a rare disease? It doesn't seem to be a rare condition as many have described such similar conditions. My rash always starts as a concentrated red patch, slightly raised. And then it starts to spread and leave the center skin un-affected. The red rash becomes a ring and radiates to the entire toso. How could the doctors say this is just allegic reaction, or eczma (eczema)? I also tried topical creams, steriod, cotizone, Elide. None worked. I am very disappointed with dermotologists I have seen. They seem to always attribute anything they don't under to common skin alleggy to soap, detergent, or eczma (eczema). Tell me something I don't know, please.

[Lemon52]

A related discussion, NUMMULAR ECZEMA /ATOPIC DERMATITIS was started.