Common problem faced by all dermatologist.
It's all because of over the counter medications by patients and misuse of topical steroids from GPs.
I usually inform the pt that treatment is for 3 to 6 months.
Itraconazole as last resource.
Try with fungicidal
Or antifungal combo
Once 90% mycological clearance, change over to pulse therapy.
Follow with topical antifungal for atleast 2 months even after 100% mycological or clinical cure
Don't you think we should review the diagnosis? Plus on quality of the medications?
For me, should further on patient's personal history, should understand why these changes and why they started at this point.
Plus, as per my experience, patients start to take medication even based on friend's consultation.
And we should ensure patient is taking medications as per our prescription. The pharmacy often changes therapy with the justification of "they have the same effect, they act the same".
We should explain our patients to take the medications as prescribed in order to see and evaluate changes further.
in my experience as I spend a little time on counselling the patients about behaviour change, like avoiding moisture, sweating, taking bath daily, drying the body properly before taking on clothes,, changing undergarments frequently washing them properly and drying them in sunlight, like ironing the clothes in in Reverse side.
prolonging the treatment specially topical treatment, two to three weeks after the lesions have healed has improved results in some patients but still I see many patients which actually are not responding to treatment and I am left with no other options to give them a break off 1 to 2 months and then to start the oral therapy again.
Other Drugs like griseofulvin has also not shown any extra benefit in fact Side Effects for increasing.
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