How to tell if a chronic rash is fungal or atopic in nature?

Question

Hi doctor,

I have had severe dermatitis for more than two years, and my dermatologist is unsure of the diagnosis, as all my blood work was normal. I have suffered from Hashimoto's thyroiditis for more than 30 years, and I take Tirosint for it. I tried many steroid creams for my skin condition, but nothing helped, and they seemed to worsen my skin condition. I took Ilumy for two months and then took Skyrizi for four weeks, but nothing helped. I tested negative for ANA and lupus as well. I attached pictures of it. Kindly give your opinion.

Answer 1

Hi,

Welcome to icliniq.com.

I saw the pictures (attachments removed to protect the patient’s identity). It is an atopic rash with a fungal infection. I suggest you take tablet Teczine M (Levocetirizine and Montelukast) once at night after dinner for ten days and tablet Loratadine 10 mg once during the day after breakfast for ten days. Apply Miconazole ointment twice daily in the morning and evening for three weeks. Kindly answer the following to help you better.

Do you have a fever?
Are you allergic to any drugs?
Do you have an itching or burning sensation?
Are you diabetic?
Do you have a history of atopy?
Have you had any fungal infections before?
Have you noticed any aggravating factors?

Answer the questions to rule out possible causes. Regards.

Answer 2

Hello,

Welcome back to icliniq.com.

Yes, it is an atopic rash with fungal infection with high margins.

Avoid triggers like spicy food, heat, sweating, sun exposure, prolonged shower, hot shower bath, harsh soaps, and scratching or rubbing the lesions.

I would recommend using a monoclonal antibody as it is a good option for allergic reactions and urticarial rash.

I hope this answers your query.

Please let me know if I can assist you further.

Thank you.

Answer 3

Hello,

Welcome back to icliniq.com.

Kindly avoid foods like chicken, mutton, fish, prawns, cheese, paneer, egg, milk, carrot, beetroot, potato, sweet potato, groundwater, chocolate, sauce, pickles, drumsticks, etc.

Try to identify the trigger and avoid it. Avoid triggers like woolen and synthetic clothes.

Use mild soap or liquid cleansers like Cetaphil cleanser (water, Cetyl Alcohol, Propylene Glycol, Sodium lauryl sulfate, Stearyl Alcohol, Methylparaben, Propylparaben, Butylparaben), and avoid conditions that cause sweating.

I suggest you use Mometasone cream twice daily. If there is no response to the steroid, then start with the following: Topical Tacrolimus ointment at night for three weeks, Teczine M (Levocetirizine and Montelukast) once daily at night for ten days, tablet Lorinol 10 mg (Loratadine) once daily for ten days after breakfast, and apply Acrofy moisturizer (Coleus oil) after bath for ten days.

If no response is seen after this, you can think of a monoclonal antibody.

I hope this answers your query.

Please let me know if I can assist you further.

Thank you.

Answer 4

Hi,

Welcome back to icliniq.com.

A monoclonal antibody is also the treatment of choice in allergic cases and atopic dermatosis.

Avoid direct sun exposure and use sun protection measures like wearing long sleeves, cotton clothes, using an umbrella while in the sun, wearing a sun coat and sunscreen, wearing broad-brimmed hats, and wearing sunglasses.

Kindly apply Photostable sunscreen (Ethylhexyl Methoxycinnamate, Methylene Bis-Benzotriazolyl, Tetramethylbutylphenol, Ethylhexyl Triazone, Bis-Ethylhexyloxyphenol, Methoxyphenyl Triazine, Diethylamino hydroxy benzoyl, Hexyl Benzoate) thrice daily for two months and apply even when indoors.

Cetaphil Moisturizing Lotion, after a bath, can be used in dry areas.

I hope this answers your query.

Please let me know if I can assist you further.

Thank you.