Dr. Dilip Kumar Meena
Dermatology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I have a rash on my upper thigh that recurs every month. The rash has been there for ten months. I have used antifungals and antibiotics, but they have not helped. Steroid creams have helped, but the rash recurs in the same area when I discontinue them. The rash starts as pimples that crust and leave dry, red, flaky patches. I am afraid it is herpes; however, I do not have wet blisters. I am attaching the pictures for your reference. Kindly advise.
Hello.
Welcome to icliniq.com.
I understand your concern. I have reviewed the pictures that you shared (attachment removed to protect the patient's identity). The rash does not look like herpes. Is it unilateral or bilateral? Also, does it itch? Kindly revert with the answers so that I can guide you better. Thank you.
Patient's Query
Hello doctor,
Thank you for the response. The rash is unilateral, affecting only one thigh, and does not itch much.
Hello,
Welcome back to icliniq.com.
It can be candidal folliculitis. It is not typically unilateral but is localized. It is characterized by follicular papules and pustules and can be recurrent, particularly in people with diabetes. I suggest the below treatment plan for a week. Take Capsule Itraconazole 100 mg twice a day. Take Tablet Fexofenadine 180 mg once at night. Use Cream Luliconazole to be applied locally once at night. Kindly revert in a week for a follow-up. Thank you.
Patient's Query
Hello doctor,
I have already used capsule Itraconazole; however, the rash keeps reappearing. Can it be herpes or eczema?
Hello,
Welcome back to icliniq.com.
No, it does not look like herpes. Both herpes simplex and herpes zoster are painful rashes. Also, herpes zoster is not recurrent. Herpes simplex can be recurrent, but it is not follicular. Another possibility is bacterial folliculitis. I suggest you apply cream Mupirocin twice a day for a week. Thank you.
Patient's Query
Hello doctor,
I used cream Mupirocin last month, but the rash has recurred. Can it be eczema? Also, is there a skin test that I can undergo?
Hello,
Welcome back to icliniq.com.
It does not look like eczema. There are tests to confirm the condition. I suggest you get a KOH mount and gram stain to rule out fungal infections like candida, dermatophytosis, or bacterial infection. If these two tests do not give any conclusive evidence, you must go for a skin biopsy, or a histopathological examination for diagnosis.
Patient's Query
Hello doctor,
I have consulted different dermatologists, and got different diagnosis like candidal infection, folliculitis, and eczema.
Hello,
Welcome back to icliniq.com.
Sometimes, it is difficult to pinpoint a diagnosis for skin conditions. A topical steroid helps in treating Candidal infection. However, it reduces only redness and itching but not the infection. Therefore, it recurs once you stop the steroids. I suggest you continue cream Luliconazole for another three to four weeks. I hope this helps. Thank you.
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Dermatology
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