Stubborn Fungal Rash

I've had some itchy spots on my inner arm near my underarm, and a few weeks ago a wider rash developed.  In one spot it seems to have the classic ringworm shape.  Before seeing my doctor, I had tried cortisone cream for a while, then switched to about a week of lamisil, then about a week of an antiseptic cream.  None of these things seemed to do much (although cortisone made the rash fade).

I saw my doctor and he said it is fungal.  He gave me two pills of 200 mg Ketoconazole, one immediately and one three days later.  I also decided to apply lotramin topically, which I hope will help.  After four days, I am not really seeing much change.  Is this going to take more time, or should we switch to another antifungal?  Is it a bad idea to be applying Lotramin externally while taking Ketoconazole internally?

[Rohit Batra, MD]

Dear DPM111,

Thanks for your query.

Ringworm or Tinea usually starts subsiding only after a week following appropriate treatment. Further, sometimes the fungus is resistant to a particular anti fungal and we have to shift to a higher antifungal to treat it. It is done only if no results are seen after 2 weeks of treatment.

There is no harm in using topical antifungal with oral antifungal medications.

However going by your history, Pityriasis Rosea (Inverse type) which occurs in folds like axilla and the first patch termed “Herald Patch" also needs to be ruled out. Pityriasis rosea is a minor bacterial infection which is treated with topical creams containing topical steroids and antibacterial.

In case you don’t see any improvement after a couple of weeks, just discuss with your dermatologist about changing the anti fungal or considering a different diagnosis.

Hope that this information helps and hope that you will get better soon.

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Best Regards,
Dr. Rohit Batra.