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Q. I have recalcitrant tinea incognito and Itraconazole did not help. Why?

Answered by
Dr. Subhash Kashyap
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Jun 30, 2020 and last reviewed on: Jul 24, 2020

Hello doctor,

I am a known case of eczema since 4 years. My eczema subsided and later developed tinea incognito since three years. My doctor advised Itraconazole oral and topical Sertaconazole, Lulliconazole, and Eberconazole on different relapses. Initially, I was responding well with oral Itraconazole which is taken for three to four weeks but since the last three months, I am having recalcitrant tinea this time. My doctor kept me on Terbinafine 250 mg BD for three weeks. I responded well but started developing lesions on the third week while still on Terbinafine. Pleas help me with my recalcitrant tinea incognito.

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#

Hi,

Welcome to icliniq.com.

Tinea incognito is a condition when a fungal infection is treated with topical steroids the symptoms subside but the fungal growth continuous and lesions are not visible, but when the steroid application is stopped larger and resistant lesions appear.

You have taken multiple courses of Itraconazole and Terbinafine and there are recurrences. This is quite common in fungal infection of these days. Treatment in your case needs to be modified.

Kindly send me a photo. Please get done renal function test and Liver function test.


The Probable causes:

Fungus tinea.

Investigations to be done:

RFT, LFT.

Treatment plan:

Combination therapy. Capsule Itraconazole 100 mg twice daily, tablet Griseofulvin 500 mg once daily. Both above after meals.
Tablet Loratadine once daily for itching, KZ soap for bathing. Keep course for four weeks as resistant cases need longer treatment.

Preventive measures:

Keep the area dry. Change undergarments daily. Treat family members. Avoid sweating, and wear airy clothing.

Regarding follow up:

After four weeks.

Thank you doctor,

Previously, I used Itraconazole 200 mg per day as I am not responding to it I was changed to Terbinafine 250 mg BD. Now again I am taking Itraconazole. Will it help me? When can I expect starting of resolution?

#

Hi,

Welcome back to icliniq.com.

Longer course of treatment is helpful in resistant cases like yours. Griseofulvin has increased cure rate in such cases in my experience. Itraconazole is a drug of choice. Buy Canditral.

Do not use steroid combination cream. Lesions clear within 10 days but recur if treatment stops earlier than four weeks in your case. Response may vary from person to person. Follow schedule and prevention strictly.

I hope this helps.


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