A Female patient aged 55 yrs presented with large, erythematous, scaly symmetrical patches on both cheeks, few lesions on right side neck.

  • More than 3 yrs duration (on & off)
  • Associated with severe itching & burning sensation
  • Unable to cook food.
  • Not a diabetic (or) Hypertensive

Known case of vitiligo vulgaris > 20 ys duration took treatment long back, with less response.  Stopped medicines 5yrs back for vitiligo later she developed this rash for which she was roaming here & there with irregular treatment.

Initially it was treated as sun burn with sunscreens & steriod creams. the rash subsided to recur again.  Patient continued same medicine (steroid abuse) after 6 months she consulted another dermatologist.  Though treatment was given for fungal infection, patient had no symptom relief.  Irritation increased & discarded the medicine.

In April 2016, she presented to our clinic with symmetrical patches.  She had severe itching & redness (unable to come out from the house.)  Patient was vexed up with medicines and refused routine lab test also clinical diagnosis of Tineafacie with polymorphic light eruption (PLE) was made.  But counselling the patent was difficult her compliance to the treatment was doubtful.  We encouraged her for minimum 3 months regular treatment.

Treatment :

1st visit – oral terbinafine 250mg 21 days

  • 2% clotrimazole cream
  • anti histamines

2nd visit – rash got exacerbated

  • moisturisers 3 times daily
  • 2% clotrimazole cream night
  • oral itraconazole bd for 2 weeks
  • anti histamines orally

Counselling her was tough

3rd visit – Good improvement was noticed

  • 100mg itraconazole Bd
  • anti histamines
  • moisturisers topically
  • 2% clotrimazole cream night daily

Still under follow up recently her husband got tineafaciei.

We are all facing similar problems recurrent/persistant fungal infection

What can we do :

  • proper drug dosages orally & topically
  • avoidance of steroid added fungal creams
  • counselling the patients about the disease, proper storage of old slips
  • importance of continuing medicines for 2-3 months
  • monthly visits made compulsory

Though fungal infection are diagnosed easily, super added dermatoses must be identified and treated simultaneously.  In our case tinea + sun allergy were there couldn’t tolerate sunscreen hence simple moisturisers were added.  To see the results (symptom free) it took more than 2 months.

Adding moisturisers to the treatment made big difference.