The history and images provided (attachment removed to protect the patient's identity) appears as tinea cruris. Tinea cruris is a fungal infection most often seen on the folds and private areas where exposure is less. They appear due to the stagnation of sweat and moisture. Private areas, groin, and buttock areas are major skin fold areas that would be affected. Underarms, under the abdomen, and folds of arms and legs are other areas to be affected. They may also form due to decreased immunity, spread from an infected person, hygiene issues, climate changes, and hormonal changes.
They present with itching, scaly lesions, sometimes oozing and foul-smelling secretion, and occasionally pain and redness. Itching is the most common feature, which may lead to discomfort throughout the day, especially when sweating.
Apart from the same, there are factors to ensure the prevention of recurrences of the same. Tinea infections are usually on and off and recur due to multiple factors. I would suggest the following:
1. Use Ketoconazole soap for bathing twice daily. Lather the soap with water and apply it to the affected areas. Keep for 3 mins and then wash off. Do not use this soap on unaffected areas.
2. Apply Terbinafine cream twice daily after bathing, clean the areas well, towel dry, air the areas to get rid of moisture, and apply Terbinafine cream well. Make sure to wash your fingers well after applying the cream.
3. Apply Terbinafine dusting powder in the afternoon and evening on the affected area to get rid of itching and absorb moisture.
4. Capsule Itraconazole 200 mg once daily at night after food for four weeks.
5. Tablet Cetirizine 10 mg one hour before going to sleep at night for one week.
6. Avoid stagnation of moisture and sweat.
7. Wear loose clothing and underwear. Make sure to wash your used belongings well and dry them under the sun daily.
8. Do not share your belongings, and make sure any of your family members or friends, if affected, need to get treatment to prevent recurrences.
9. Capsule Becosules Z (Vitamin B complex, Vitamin C, and zinc) may be used once daily after breakfast for one month to maintain immunity.
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