Navigating the Confusion of Rash Treatments: Steroids vs. Fungal Infections
I'm a 43-year-old male, standing at 5 feet 11 inches tall and weighing 165 pounds, generally in good health. A routine check-up last month indicated that all my health markers were well within normal limits. However, I've recently encountered a rash around the outer edge of my armpit. Initially, I diagnosed it as intertrigo, a fungal condition typically seen in skin folds. To address this, I applied ketoconazole for nearly three weeks and used Sudocrem overnight, which effectively cleared it up Shortly after, due to frequent washing and the use of various powders like Zeabsorb, I noticed another rash forming on the left outer rim of my armpit, presenting with numerous red spots. After applying Sudocrem overnight, many of the spots diminished, yet the larger ones continued to expand until they merged. Following a single application of hydrocortisone, which only seemed to exacerbate the irritation, I switched to Lamisil (terbinafine), applying it twice daily, suspecting it might be ringworm based on advice from a telemedicine consultation. Five days into using Lamisil, the rash appeared to worsen, resembling a blotchy patch rather than ringworm. Although Lamisil is effective against tinea, I am aware that its efficacy against other fungal infections like candida or malassezia can be limited, especially since I also battle seborrheic dermatitis. Today, a nurse practitioner suggested I transition to a steroid treatment, believing the condition to be dermatitis rather than fungal in nature. I inquired about a combination cream that incorporates both antifungal and steroid elements. This brings me to my dilemma: I've come across discussions about tinea incognito, and I’m uncertain if it’s advisable to use steroids given the potential risks. Should I finish the full week of Lamisil at twice daily to ensure any possible fungal infection is fully addressed before moving on to a steroid cream? I find myself perplexed about my next steps. Continuing with Lamisil may risk worsening the dermatitis, while using a steroid might aggravate a fungal infection. How do I choose the appropriate course of action when the diagnosis is still unclear? Unfortunately, getting a timely biopsy in Canada is challenging due to long waitlists for dermatology appointments.
Answers (1)
9/15/2025, 8:21:00 PM
OpenHealth AI
It's understandable to feel confused and frustrated when dealing with a persistent rash, especially with the potential overlap between fungal infections and dermatitis. Here’s a structured way to approach your situation based on your description.
Main Points:
- Your rash may be either a fungal infection or dermatitis, making it essential to carefully choose your treatment.
- Continuing with Lamisil may not be beneficial if your condition is indeed dermatitis, while using steroids could exacerbate a fungal infection.
Explanation: You’ve already made some attempts at treatment, which is great, but the lack of clear improvement makes it a bit more complicated. Fungal infections, like tinea, typically respond to antifungal treatments such as Lamisil (terbinafine). However, if the rash is actually a form of dermatitis or there is an element of skin irritation from the product you’re using, keep in mind that steroid creams can potentially worsen a fungal infection if applied inappropriately.
Given your situation:
- The application of hydrocortisone did not help and may have worsened irritation, suggesting that it might not be the right path if you’re dealing with a fungal issue.
- Understanding tinea incognito is vital, as using steroids could mask symptoms and lead to an inflammatory response if an underlying fungal infection is present.
Next Steps:
-
Finish the Lamisil Course: Complete the current regimen of Lamisil for the full week if the rash does not significantly worsen. Monitor the rash closely; if improvement is noticed, this is promising. However, if you see worsening with Lamisil or no improvement, you can stop after that week.
-
Monitor Symptoms: Track any changes in the rash and symptoms. Look for signs of improvement, such as reduced redness and scaling, or resolution of itchiness. If it continues to expand or you develop new symptoms, it will warrant reconsideration.
-
Hydration and Skin Care: Focus on keeping the area dry and clean. Avoid excessive washing, which can irritate the skin more. Gentle cleansers and non-irritating moisturizing creams can help soothe the skin.
-
Consider OTC Combination Creams: If improvement is noted with Lamisil, discuss options for combination creams with your healthcare provider. Brands that combine antifungal and mild steroid properties may help if you are able to get an appointment or are referred to a dermatologist.
-
Seek Professional Guidance: If the rash shows no signs of improvement after your Lamisil course, consider following up with your healthcare provider for a better-structured treatment plan, including a potential biopsy or alternative treatments.
Remember, skin conditions can sometimes take time to resolve, and patience, along with careful observation, will be key in your recovery. You are taking the right steps by seeking clarity and ongoing treatment until you find what works best for you.
Related Questions
Persistent Pain in Right Shoulder and Arm After Lifting
Hello, everyone! I’m a 23-year-old male and have been engaged in weightlifting for several years now. Recently, I’ve been struggling with ongoing discomfort in my right shoulder and arm, which I haven’t been able to accurately identify. The pain manifests during particular movements, especially with lateral raises or when my arm is raised to shoulder level while rotating my wrist. Certain pressing and pulling activities can also provoke this discomfort. Rather than feeling sharp, it’s a deep, nagging sensation that sometimes seems localized in the front area of the shoulder or at the biceps tendon, and at other times it feels more like it’s situated between the shoulder and upper arm. Fortunately, there’s no numbness or tingling involved. This issue began while I was working out. I decided to take a break for around two months, but when I returned, the pain persisted. After consulting a physician, I was diagnosed with bicipital tendinitis. Since then, I’ve reduced my upper-body workouts, completely steering clear of shoulder exercises and heavy lifting, and have begun a gentle rehabilitation regimen focusing on external rotations, pendulum movements, and scapular exercises. Despite adhering to this routine for about a week, I haven’t experienced any noticeable improvement. Is it typical for this type of tendon injury to require an extended period for recovery? At what point should I consider diagnostic imaging, such as an ultrasound or MRI? Additionally, are there frequent rehabilitation errors that might impede the healing process? I appreciate your insights in advance!
Understanding EEG Results for My 22-Month-Old Son: Insights Needed
Could someone help clarify this for me? My son, who is just 22 months old, hasn’t started walking yet, becomes tired easily, and has been experiencing behavioral outbursts. He had a febrile seizure in February 2025, followed by another unexplained seizure in April 2025, which led us to consult a neurologist. Since he was 3 months old, he has been receiving therapy from a physical therapist for torticollis. At birth, he spent five days in the NICU due to issues with meconium aspiration. A recent MRI showed normal results, and he also had a follow-up EEG after one conducted in July 2025. The results from this recent EEG were abnormal for a pediatric patient in awake, drowsy, and sleeping states. Notably, there were brief episodes of left frontotemporal delta slowing, which occurred mainly when he was awake and drowsy. There were no signs of epileptiform activity detected. In contrast, the EEG performed back on July 3, 2025, was deemed normal for both awake and drowsy states, again with no evidence of epileptiform irregularities, although it did not capture any sleep data. This examination was prompted by the child's existing history of febrile seizures. Importantly, he is not currently on any anti-seizure medications. The EEG procedure used standard electrode placements per the 10-20 system, conducted a single-lead EKG, and included continuous video monitoring. During the analysis, the background activity was symmetric, indicating some anterior-posterior (AP) organization, with a dominant rhythm of 50-80 microvolts at 7 Hz. His drowsy state was marked by a reduced amount of eye blink activity, less breathing motion interference, and a generalized slowing in theta/delta frequencies. Stage II sleep exhibited spindles and vertex waves patterns. Additionally, there were intermittent bursts of 250-300 microvolts in the left frontotemporal region with semi-rhythmic activity of 2-4 Hz, mostly observed during wakefulness and drowsiness. No definitive epileptiform discharge was noted. Photic stimulation during the test did not elicit a strong response, and hyperventilation was not conducted during this session.
INTENSE Spine Discomfort, Breathing Difficulties, Muscle Twitches, and Sweating
To elaborate on the situation mentioned in the title, I’ve been experiencing unusual muscle twitches and spasms for the past few days, along with some discomfort in my back. However, today, I felt an unexpected sharp pain shoot through my spine, which has left my legs feeling numb and made it impossible for me to sit up straight. Additionally, I’ve been dealing with cold sweats for the last hour and struggling to breathe properly. Perhaps I’m just overanalyzing things and it’s a common occurrence, but the intensity of the pain is overwhelming—it's truly unbearable. I’m shaking quite a bit, and unfortunately, my parents aren’t responding to my attempts to reach them for help. I have a history of a chronic heart condition and arthritis, yet I’ve never experienced pain this severe, especially in my spine. For context, I am nearly 15 years old and female. My current medications include pain relievers, anxiety medication, beta blockers, and some vitamins, though those specifics may not be particularly relevant. I don’t smoke; however, I have tried vaping a few times, which might not matter much, but I thought it was worth mentioning as it was requested.
28-Year-Old Male Experiencing Scalp Sensations Post-Amitriptyline Treatment
I am a 28-year-old man in generally good health, without any cardiac concerns. Approximately a month ago, I encountered intense pain localized to one side of my head, which was unresponsive to paracetamol. However, a single dose of a migraine treatment provided substantial relief. Following that, I began a regimen of amitriptyline, starting at a nightly dose of 10 to 25 mg. While my head pain has diminished significantly—by about 90 to 95%—I now experience occasional uncomfortable sensations on my scalp. These feelings include pins and needles, a cooling sensation, and some crawling feelings near my hairline and ears. There are fleeting moments where I feel brief throbs lasting a second, but I do not have any persistent headaches. To clarify, I do not experience any of the following: - Nausea - Weakness in my limbs - Numbness - Changes in my vision - Coordination difficulties - Seizures The symptoms I have are transient, shifting around and often intensifying when I become conscious of them or as the day progresses. I would like to know: Is it common to experience these sensations during the recovery stage following episodes of neuralgia or migraine-like discomfort? Additionally, could the amitriptyline potentially be causing these temporary paresthetic sensations? I am seeking some reassurance or advice on what is typically observed during this healing process. Thank you.
Concerns About My Toes
Age: 30, Female Currently, I am on the lookout for a reputable podiatrist in my vicinity. However, I've encountered a perplexing issue with my foot. Just last night, I noticed a growth on the side of my toe, something entirely new to me. I maintain a nutritious diet and have a demanding job that requires me to be on my feet quite often. My footwear includes brands such as Brooks Ghost Runners, Hoka Bondi 9’s, and Nike Motiva’s, and I don’t opt for restrictive socks. I also apply Vick’s Vaporub to my feet, a practice handed down from my family, and stick with simple, non-fragrant lotions like Vanicream and CeraVe SA Cream for my skin. In addition, I am curious about the my big toenail's change in color. What might be the underlying reasons for this? Also, I have these persistent dark spots on my toes that I've struggled with since my days on the runway. Despite my efforts, nothing has succeeded in lightening or diminishing their appearance. I'm just looking to determine if there might have been a factor from the past that could have contributed to these issues. I’m not sure what else to include, but I’m open to answering any questions you might have. Thank you for your attention! Best wishes from a worried soul!