Skin infection?

[unechaise]

My boyfriend has this discoloration all over his stomach, armpits, and groin area. It's darker than his skin color and he's had it since he was a teenager, and he's 25 years old now. It looks like pityriasis rosea but when I researched that it only said it lasted for a few months tops. I don't know if it's a fungus or an infection. He said he was treated for it once, but never got a refill on his prescription and he couldn't remember the diagnosis. I was wondering if you could gice me an idea of what it might be? Thanks!

[Dr Santos]

Hi,

If the skin is darker than his skin color, this could be hyperpigmentation which is caused by increased melanin. This may be caused by sun damage, inflammation, or other skin injuries. Hyperpigmentation is associated with a number of diseases or conditions, including: Addison's disease and other sources of adrenal insufficiency,  Cushing's disease or other excessive adrenocorticotropic hormone (ACTH) production,  Acanthosis nigricans, associated with insulin resistance, certain chemicals, smoker's melanosis, Celiac disease or  fungal infections such as ringworm.

Are there other signs or symptoms present? Can you elaborate on the appearance of the skin lesion? Diagnosis of a fungal infection would be through analysis of the skin scrapings under the microscope. It would be best to have it evaluated by a dermatologist to rule out other causes. Treatment of hyperpigmentation may include hydroquinone, kojic acid, azelaic acid, ascorbic acid, tretinoin, topical glucocorticoids, and licorice extract.

Take care and keep us posted.

[unechaise]

Dr. Santos,

I talked to my boyfriend some more about his skin lesions, and he said that he remembered it was some sort of fungus. The lesions are big; there is a giant one that covers his stomach and is connected to the one that covers his groin area, and there is a lesion under his right armpit big enough to see when his arm is hanging down naturally. My boyfriend is a bit chubby, and he doesn't expose his stomach/chest/upper arms to any sun; he always wears either a t-shirt or polo shirt; no tank tops. The lesions are sort of a tan color; it would look like he had a tan if he were covered completely in lesions. I have a spot of ringworm on my left shin right now, and his lesions don't look a thing like my ringworm. As far as I can tell his lesions are not contagious, for I have not gotten whatever it is he has, and we've been together for almost four years.

[unechaise]

P.S.

He says it stings when he sweats, and that it is underneath his skin.

[Dr Santos]

Hi,

Fungal infection may occur in any part of the body. They thrive in warm, moist areas and may be contagious. If the fungus is found in the feet, it is called tinea pedis, if it is a ringworm such as yours, it is called tinea coporis. Your boyfriend may have tinea versicolor or intertrigo, depending on the appearance.

Tinea Versicolor is a fungal infection of the outermost layer of the skin. It is most prevalent among adolescents and adults but can affect children. The main symptom is discoloration. Variable pink, white, or brown patches develop on the skin. A powdery coating is also present. It can remain dormant within the hair follicles for long periods of time. With proper moisture and temperature conditions, the fungus becomes active and reproduces. Topical antifungals are usually used for treatment because the infection is on the surface of the skin rather than in deeper tissue.

Intertrigo, on the other hand, is a yeast infection of skin folds caused by Candida albicans. It usually occurs in areas of the body that have skin touching skin such as the armpits, groin, and under heavy breasts or fat folds. It is characterized by an intensely red, macerated, glistening rash with scaling on the edges. The edge of the rash extends just beyond the limits of the opposing skin folds.

Some people are much more susceptible than others. Some people are genetically predisposed, and can get it easily throughout life. It would be best to have it evaluated by a dermatologist for proper management. Take care and keep us posted.