Resistant tinea problem

[Alan1934]

What are the health implications for a 78 year man with chronic seborrheic dermatitis on his face, a large patch on his hip and scattered lesions on his leg with chronic fungal infections of his toes and one finger nail. The lesions are resistant to terbanifine and all topical anti-fungals. He has had repeated courses of antibiotics for a non diabetic neuropathic ulcer on his big toe  now amputated. He has had a x4 cardiac bypass and has stable CKD4

[Alan1934]

Thank you very much for this comment. I have indeed been under some long standing stress with medical problems. I am finding that the anti fungals do not seem to work but a combination of Selsun (Selenium Sulphide) plus intermittent mometasone helpful. Thank you for the suggestion about UV light. We have had a relatively poor sunshine summer so I will take a much needed holiday in the sun.

[Bhupinder Kaur, MD]

Hello,
Seborrhoeic Dermatitis is believed to be an inflammatory reaction related to the proliferation of normal skin habitant Malassezia – a yeast, which produces toxic substances that infect and irate the skin. The disease is neither contagious nor related with diet but it may be aggravated by other illness like Psychological stress, immune compromised patients etc.

Treatment usually involves use of antifungal, anti inflammatory and sebo suppressive or Keratolytic ingredients. Dermatologist also recommends the use of photodynamic therapy which involves the usage of UV- A, UV- B laser and red or blue LED light to inhibit the growth of the yeast and reduces the inflammation. Also exists Pulse Therapy. Therapeutic choices for pulse therapy may include non fluorinated class 111 steroids such as mometasone furoate or an extra potent class 1 and 11 topical steroid such as clobetasol propionate or fluocinonide.
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. I sincerely hope that helps. Take care and please do keep me posted on how you are doing.

[Alan1934]

As the one who posted this I can say I saw my Doctor who said the lesion on my hip was discoid eczema and those on my leg were dry skin. Not entirely convinced of this but will see the result of Betnovate for the 5cm lesion on my hip and Dermol emulsion for the leg. As for my face I am using Tea Tree oil and hydrocortisone. I just wondered if I could have an immune problem.