Are my red and white patches fungal or pityriasis?

Question

Hello doctor,

I have been dealing with a skin condition, but I am not sure what it is called. I have red patches on my skin and white patches on my face.

I first consulted a dermatologist who prescribed Ketoconazole shampoo, Itraconazole 100 mg tablets, and Afun one percent cream. I have been using these for about 10 days, but there has been no improvement.

I then consulted another dermatologist, who diagnosed it as pityriasis rosea and said it is not a fungal infection. The treatments prescribed by both doctors are different. One has given medications without steroids, while the other has prescribed a steroid-based ointment.

I am confused about which treatment to follow. What should I do?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query.

I completely understand how confusing and frustrating this situation can feel, especially when you receive two different diagnoses and treatment plans.

From what you have described, one doctor treated you for a fungal infection using Ketoconazole shampoo, Itraconazole tablets, and an antifungal cream. The second dermatologist, however, diagnosed pityriasis rosea (a temporary skin rash that usually clears on its own), which is not a fungal condition and usually does not respond to antifungal medicines.

Since you have not noticed any improvement even after 10 days of antifungal treatment, it slightly suggests that this may not be a fungal infection. However, it is still not possible to be completely sure without examining your skin closely.

To guide you more accurately, I would need to see clear photos of the affected areas on your face and body. Some skin conditions like pityriasis rosea, tinea versicolor (a common fungal skin infection that causes lighter or darker patches on the skin), vitiligo (a skin condition where patches lose their color due to loss of pigment cells), and post-inflammatory hypopigmentation can look quite similar, especially in the early stages.

Along with the photos, please share a few more details:

When did the rash first start?
Did it begin as a single larger patch before spreading?
Do you feel any itching or notice scaling?
Do the patches become more visible after sweating or sun exposure?
Is anyone else around you experiencing similar symptoms?

For now, it is best not to mix both treatment plans. Avoid using steroid creams on your face unless the diagnosis is clearly confirmed, as they can sometimes worsen fungal infections and may cause side effects like thinning of the skin or acne.

If the patches are not itchy, oval in shape, and spreading along the natural lines of the skin, especially on the chest or back, pityriasis rosea is more likely. This condition usually settles on its own within four to eight weeks and may only need simple care like moisturizers and medicines for itching if required.

On the other hand, if there is fine scaling along with lighter or white patches, especially on the face or body, a fungal condition like tinea versicolor could still be possible. In such cases, treatment may take a little longer, sometimes two to four weeks or more, to show visible improvement.

The safest next step right now is to pause and reassess instead of continuing two different treatments together. Please send me clear images and the details I asked for, and I will help you narrow down the diagnosis and guide you with the right treatment plan.

I hope this helps.

Kindly revert so I can assist you further.

Thank you.