What causes a relapse of skin problem following the use of an antifungal cream in an autoimmune hepatitis patient?

Question

Hello doctor,

I have a skin problem for the past two months. I consulted a general medicine doctor who prescribed me Dermiford antifungal cream. It worked well for one month but after that, the problem came back. Now, it is spreading all over my body. I have already been taking the steroid tablet Prednisolone because I am an autoimmune hepatitis patient. I also have itchiness. Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I appreciate the confidence that you place in me for your health care consultation.

From your description, it seems to be a superficial fungal infection. I suggest you do the following:

Use Ketoconazole soap for bathing for two months.
Take a tablet of Levocetirizine 5 mg at night for seven days (if you have irritation).
Stop using the steroid if there is no inflammation since you are having a metabolic problem or liver issue.

Kindly answer the below questions to arrive at a definitive diagnosis.

Are you on some systemic medications?
Have you done any liver function tests in the past?
Do you have any widespread rash?
Do you have any annular inflammatory lesions with elevated margins or borders?

Do reply and share an image of your condition.

I hope this helps.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

Glad to have you back.

From your description and attached images (attachments removed to protect the patient's identity), it appears to be Tinea corporis. I suggest you do the following:

Use Ketoconazole soap for bathing for two months.
Apply Terbinafine cream twice daily for six weeks.
Do not scratch or rub the lesions.
Avoid occlusive tight clothing.
Keep the area clean and dry.
Avoid scratching and rubbing the lesions, as nails can harbor fungal molds.
Keep the nails short.
Avoid activities that cause sweating.

I hope this helps. Do get back if you have any further queries.

Thank you.