brown rash above anus.

I am a 28 year old male.  I'm neither diabetic nor obese.
Two weeks ago, i noticed a red rash above and around my anus. I had sweated heavily the night before, and used a public toilet at work several times that night as well. the rash is completely painless and does not itch.  I let the rash go for one week, thinking it would heal up on its own. it did "heal" a little bit in the first week (without treatment). It turned from a deep reddish brown to a sort of light brown. After one week with the rash, i went to an immediate care facility thinking it was a fungal infection. The immediate care physician looked at it and told me it was fungal. He prescribed me Clotrimazole/Betamethasone 1% / .05% cream. (made by Taro pharmaceuticals). This stuff simply does not work. I have  been applying it to the area twice a day and have seen no results. the rash maintains the same light brown color and does not seem to be healing after 6 days of using the prescription cream.
There is also something else that i am curious about regarding this rash.
Today, i looked at it and it appeared very light, almost like it was healing. I then got in the shower and when i got out of the shower i looked at it again. It was darker. I dried the area and applied the cream and it still appears the same old light brown color. I'm a meticulously clean person and i'm starting to have a doubt that this thing is fungal. From what i've read, fungal rashes are red and itch. This one is brown and does not itch. It just looks like a discolored area in my butt crack. I'm getting impatient. Doctor, can you offer me some insight as to what you think this rash could be? anyone else have experiences like this?
Thanks.

[Jasmina Jankicevic, MD, MSc, CCRP]

Welcome to the Dermatology Expert Forum!

Perianal rash can be caused by microbial infection (bacterial, fungal, viral), allergic contact dermatitis, irritant contact dermatitis, allergy to systemic drugs, lichen sclerosus & atrophicus, etc. Detailed medical history needs to be taken by a physician! Although often present, pain and/or itch are not mandatory subjective symptoms of perianal rashes.

If fungal infection clinically seems like most probable cause, that should be confirmed by laboratory test (skin culture) and then treated by an antifungal cream such as clotrimazole, ketoconazole, etc (without topical corticosteroids).

Light brown color of once inflamed lesion is most likely post inflammatory hyperpigmentation. It should subside in several weeks.


Wishing You Optimal Health,
Dr. Jasmina Jankicevic

[ParanoidaboutHiv]

My dermatologist has given me EC/HC cream Econazole Nitrate 1%/ Hydrocortisone 1%.
do doctors have differing opinions on the use of cortico steroids? he hasnt done a culture. he just looked at it and gave me the cream. he's a reputable doctor in downtown chicago. do you think i should go get a second opinion? do you know of any doctors in the chicago area who wont just take a quick look and make assumptions? i want to get a culture and i really dont like what i read about steroids.