My mother has itching despite Betnovate. Is a skin test needed?

Question

Hello doctor,

My mom is 55 and has had diabetes for many years. Recently, she developed very itchy patches on her lower legs and ankles. Skin became thick and dark in some places due to scratching.

The local doctor gave Betnovate cream to apply twice daily. It reduces itching, but the rash comes back after some time. I want to know the following:

Can diabetes make eczema worse or slow the skin healing?
Also, sometimes patches spread a little bit, so we are wondering whether it could be a fungal infection instead of eczema?
Do we need any skin test or scraping to confirm?

Kindly suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I am sorry your mother is dealing with this. It can be very uncomfortable, especially when the itching keeps coming back. In people around your mom’s age who have long-standing diabetes mellitus, itchy skin problems on the lower legs are quite common.

Diabetes can affect the skin in several ways: it can cause dryness, reduced blood circulation, and slower skin repair, which all make the skin more vulnerable to irritation and inflammation. Because of this, conditions like eczema can become more persistent and take longer to heal.

The symptoms you described, very itchy patches, thickened skin, darker areas from repeated scratching, and recurring rash, are often seen in chronic eczema or in a condition called Lichen simplex chronicus, where continuous scratching leads to thick, leathery skin on the legs or ankles.

The medication she was given, Betnovate (which contains Betamethasone valerate), is a topical corticosteroid used to reduce inflammation and itching. It often gives quick relief, but it mainly suppresses the inflammation rather than fixing the underlying cause of dryness or irritation.

That is why many patients notice that the itching improves while using the cream, but returns after stopping it.

With chronic eczema, doctors often combine steroid creams for short periods with regular heavy moisturizers and trigger control to maintain improvement.

However, because your mother has diabetes and the rash keeps recurring, it is important that steroid creams are used carefully and not continuously for long periods, since long-term steroid use can thin the skin and sometimes mask other conditions.

Your concern about a fungal infection is very reasonable. In people with diabetes, fungal skin infections occur more easily because higher blood sugar levels can support fungal growth and weaken the skin’s natural defense.

Some fungal infections, such as Tinea corporis (ringworm of the body), can appear as itchy patches that slowly spread outward, sometimes with darker or slightly raised borders.

When steroid creams like Betnovate are used on a fungal infection, they may temporarily reduce redness and itching, but do not kill the fungus, and the rash can gradually spread or change appearance.

In fact, steroids can sometimes make fungal infections harder to recognize, a situation doctors sometimes call steroid-modified fungal infection.

Because the patches are persistent, spreading slightly, and recurring after treatment, it would be reasonable for her doctor or a dermatologist to consider a simple skin test, such as a skin scraping with potassium hydroxide (KOH) examination or sometimes a fungal culture.

This test is quick and painless. A small sample of skin scales from the rash is examined under a microscope to check for fungal elements. Doing this test can help clearly distinguish between eczema and fungal infection, which is important because the treatments are very different.

I hope this helps.

Thank you.