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:
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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.
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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.
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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.
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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.
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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.
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