Dr. Shanza Ikram
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 rashes in my anus, sides of my testicles, and lower testicle skin area. The whole area turns red with scratching. I have had this for more than a year. So, I have consulted with a dermatologist and tried several products suggested by pharmacists. I tried Corticosteroids, Zinc oxide, and antifungal medicine. But nothing helped. One problem that may or may not be related is tiny external hemorrhoids in the perianal area. I seem to have this issue only sometime after I take a shower at night. In the middle of the night, I wake up with a massive rash. I ignore it for the most part because of its size, and it does not bother me. I also cannot associate any food allergy with this. Kindly help.
Hi,
Welcome to icliniq.com.
I have gone through your case (attachments removed to protect the patient’s identity). In my opinion, steroids alone cannot help. Combination of Clotrimazole and steroid are usually effective along with oral medicine. Most of the time, this problem is chronic and runs for a long time. I would also like to see the picture. If possible, kindly send few photos of your lesion for better comment. Thanks.
Patient's Query
Hello doctor,
Thanks for the reply. I tried Clotrimazole already for two weeks as indicated, and it did not work. So, I am guessing it is not a fungal infection. Could this be connected to my hemorrhoids in any way? I am not diabetic. I have attached two pictures. Thanks.
Hello,
Welcome back to icliniq.com.
Yes, you need a prolonged treatment along with a few precautions. Kindly avoid sweating and friction as much as you can, and wear loose clothing. I suggest you consult with a specialist and take the following medication with their consent. A capsule of Fluconazole 150 mg once a week for at least four weeks, mix Hydrocortisone cream and Clotrimazole cream in equal amounts and apply two times a day for four weeks. Take care.
Patient's Query
Hello doctor,
Thanks for the reply. It is fine if the hemorrhoid is coincidental. I also have on and off wounds on the sides of the lips. What could this be? Thank you.
Hello,
Welcome back to icliniq.com.
Regarding your hemorrhoids, it is skin tags, and it is due to friction. It can be removed by cautery. The lesion on your lips are angular cheilitis. The causes include oral candidiasis, which is a type of fungus. It will get improved with capsule Fluconazole and a mixture of Clotrimazole and Hydrocortisone cream. Maintain good oral hygiene and do saline gargles every four hours. Improve your vitamin B12 levels and hemoglobin level. Take a multivitamin capsule once daily for one month. Regards.
Patient's Query
Hi doctor,
Thanks for the reply. My diet is mostly vegetarian, so I am assuming my vitamin and mineral levels are good. I do take a sublingual vitamin B12 supplement. I will look into hemoglobin levels. Thanks.
Hello,
Welcome back to icliniq.com.
Yes, it is good to check your hemoglobin. I would recommend you consult with a specialist and take capsule Perfectil (Biotin, Silicon, Astaxanthin, Burdock extract, Vitamin, Minerals, 21 essential micronutrients) once daily for one month with their consent. Regards.
Patient's Query
Hello doctor,
Thanks for the reply. I followed your advice regarding Fluconazole, Clotrimazole, and Hydrocortisone as directed above. As soon as I stopped, the itching came back. What should I do? Thanks.
Hello,
Welcome back to icliniq.com.
How is your lesion? Are they still aggressive? What about your angular cheilitis? I would like to see a fresh photo of the lesion for further comment. And please tell in detail about the amount of oral Fluconazole you have taken. These are very important questions for better comment. Thank you.
Patient's Query
Hello doctor,
Thanks for the reply. I took four Fluconazole (150 mg) tablets, one per week, as you indicated. During that period of time, I applied Clotrimazole and Hydrocortisone twice a day for 30 days. I have attached photos of the angular cheilitis and also the perianal area. The perianal area looks better because I was not scratching. Thank you.
Hello,
Welcome back to icliniq.com.
I have reviewed your pictures (attachment removed to protect the patient's identity). Yes, improvement is there. Please take two more tablets of Fluconazole and apply Clotrimazole cream (consult with a doctor, talk to them and take the medicines with their consent). As your issue is chronic, it is better to taper off the medications instead of stopping them abruptly. So keep on using Clotrimazole but stop Hydrocortisone. And also, continue your multivitamin. Kind regards.
Patient's Query
Hello doctor,
I took the two extra tablets of Fluconazole, as indicated, and kept applying Clotrimazole, but because I stopped taking Hydrocortisone, also as indicated, the itching came back, and so did the redness. Clotrimazole did not help; it just looked like it did because I was not scratching while I took steroids. Are you sure this is a fungal infection? Is there another course of action I can take since this is not helping? (There was no time gap between the six tablets of Fluconazole, I took it for six weeks once a week.) Thank you.
Hello,
Welcome back to icliniq.com.
Can you send me a current picture of your condition?
Patient's Query
Hello doctor,
Sure, doctor, I took these pictures just now. Thanks.
Hello,
Welcome back to icliniq.com.
In my opinion, your previous skin condition has improved a lot. But I have noticed two more things. In the first and second pictures (the attachments have been removed to protect the patient's identity), there are two to three warts or skin tags present. And many scratch marks in the second last picture (the attachments have been removed to protect the patient's identity) are seen, which could be from scabies. For this, apply 5 percent Permethrin lotion at night on the whole body and take a bath in the morning. For warts confirmation, you need to see and get examined by a local doctor. But now stop everything antifungal, especially oral medicine. But you can continue Clotrimazole cream locally if it gives you some relief, even if it is minor.
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