9/1/2023 0 Comments Steroid antifungal cream![]() Moulds, resulting in tinea nigra and nail plate infections.Ī topical antifungal medication is a cream, solution, lotion, powder, gel, spray or lacquer applied to the skin surface to treat a fungal infection.Yeasts, resulting in candida intertrigo and pityriasis versicolor.Dermatophytes, resulting in tinea corporis, tinea cruris, tinea faciei, tinea manuum, tinea pedis, tinea capitis and tinea barbae.Persistent and recurrent tinea corporis in children treated with combination antifungal/corticosteroid agents. Clotrimazole/betamethasone diproprionate: a review of costs and complications in the treatment of common cutaneous fungal infections. Erin Dahlke Suggested Papers for Further Reading:ġ. Use caution when prescribing strong topical steroids.Do not use corticosteroids on dermatophyte infections.If the fungal scraping is positive, treat with antifungal therapy, monotherapy.If the scraping is negative and the diagnosis is unclear, consider referral to dermatology for a skin biopsy for diagnosis (+/- repeat scraping).If a fungal infection is suspected, confirm the diagnosis prior to initiating treatment.Unfortunately for her (and the prescribing doctor), her disfiguring stretch marks are permanent. She had been prescribed lotriderm for a presumed fungal infection, and as the area continued to be red (which was, in fact, atrophy from the treatment) she continued to use it. I recently reviewed a case of a teenage girl with horrific striae, erythema, and telangiectasia between her breasts. There is a real risk of atrophy, telangiectasia, striae, purpura, bruising and hair growth in addition to HPA axis suppression, growth retardation, immunosuppression and impaired wound healing (although perhaps this is more theoretical).Ī product like lotriderm (topical azole and betamethasone diproprionate) is often prescribed by primary care docs unsure of how to treat a rash.īetamethasone diproprionate is a class 1/2 steroid (meaning highest potency), very different from betamethasone valerate, an entirely different, milder, medication. The use of even mid-potency topical steroids can have serious consequences if used chronically, and sometimes even from short term use. ![]() However, it raises the question – what is the risk of rebound upon discontinuation? This can result in steroid dependency to quell inflammation caused by a dermatophyte infection. There is industry-sponsored evidence to support the use of these lucrative combination products and short term clinical cure is an easy endpoint to achieve when you add an anti-inflammatory agent. Secondly, combination steroid/antifungal products should not be used for superficial dermatophyte infections. Even then I will always do a fungal scraping and have the patient follow up to ensure treatment is effective. tinea cruris with horrific onychomycosis, tinea pedis, and a new annular erythema with a characteristic leading edge of scale in the groin) and the differential diagnosis is short. Occasionally there is an obvious diagnosis of a dermatophyte infection (i.e. In addition to the list outlined above, more dangerous pathology such as cutaenous T-Cell lymphoma can be treated as tinea or psoriasis for many years before an accurate diagnosis is made. In these cases I will do a fungal scraping, KOH examination, and skin biopsy then wait for the results before initiating treatment. Yes, tinea corporis is one of these diagnoses, but very often the diagnosis is unclear. Tinea corporis, psoriasis, erythema annulare centrifugum, allergic contact dermatitis, lichen planus, cutaneous T-cell lymphoma, eczema, subacute cutaneous lupus erythematosus, discoid lupus erythematosus, pityriasis rosea, secondary syphilis, polymorphous light eruption, annular seborrheic dermatitis, erythrokeratodermia variabilis, leprosy, etc. When presented with an annular erythema with scale a number of diagnoses run through my mind. Firstly, treating blindly is poor medicine.
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