Dear Doctor
Aged 68, male. Two months back a small white dot seen in the middle of forehead. Consulted with the Doctor. He said fungus infection, prescribed Tenovate tm-m.
I was using Nivea cream in summer which was three years old. Even after two months there is no visible result but gradual enlarging slightly. Now it has become a circle in reddish color.
While I was using the tenovate I used to have sun light on the forehead for three weeks. Doctor asked me to stop that.
I also applied Flucort-h simultaneously in order to subside further enlarging. But still it remains as it is.
What is the next remedy?
Dear Patient
This condition is known as Tinea Incognito.
Causes of Tinea Incognito
It is caused by applying corticosteroids like clobetasol propionate (Tenovate) and fluocinonide (Flucort) to fungal skin infections.
Applying Calcineurin inhibitors like Tacrolimus (Protopic) and Pimecrolimus (Elidel) to Tinea corporis (ringworms) can also cause Tinea Incognito.
Symptoms of Tinea Incognito
Symptoms of Tinea Incognito include a gradually enlarging circle which does not look like a typical ringworm since it is less scaly and the border less defined.
It may also be itchy and this itch is worsened by not applying the steroids.
Treatment of Tinea Incognito
The treatment includes:
1. Stop applying the steroid creams or calcineurin inhibitors
2. Go for a KOH skin prep test to confirm that the underlying condition is really a fungal infection. I would advise that you wait for a few days after stopping the steroid cream before going for the KOH test because the steroid creams can cause the test to be falsely negative.
3. Apply an antifungal cream like Clotrimazole cream for around 4 weeks. The skin lesions will clear within a week or two (clinical cure) but you must continue applying the antifungal cream for 2 more weeks after they disappear to ensure that all the fungi are eradicated (mycological cure).
Other antifungal creams that can be applied include Terbinafine, Miconazole, Ketoconazole and Econazole creams.
4. Get a prescription of antifungal tablets that you can take by mouth. Examples include Terbinafine 250 mg taken once daily for one month or Itraconazole 200 mg taken once daily for 7 days.
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