Brief Answer:
Tinea cruris; antifungals (oral+topical)

Detailed Answer:
Hello. Thank you writing to us at healthcaremagic

I am Dr. Kakkar. I have gone through your query.

You seem to have Fungal Infection of the groin folds (Tinea Cruris). Groin folds provide an ideal environment for the fungus to proliferate because of the moist, humid conditions that prevail in the folds, specially in hot and humid weather of summers.
Itching is usually bothersome in Tinea cruris and can be embarassing.

If I was the treating doctor I would have started you on oral antifungals e.g either fluconazole or terbinafine.
Oral antifungals are faster acting and control the infection much better when used in combination with topical antifungal creams. Topical creams alone are sometimes not totally effective if the area of involvement is extensive.

In addition to oral antifungals, I usually ask my patients to use a topical plain antifungal e.g either clotrimazole, which is available OTC Or one of the prescription antifungal e.g Sertaconazole, Luliconazole, Bifonazole etc. They need to be used regularly, twice daily for 4-6 weeks.
You have already been using a plain antifungal, irregularly though, for past 2 weeks and I would suggest that you stick to that. Use it regularly, twice daily for 4-6 weeks.

I usually avoid combinations (with steroid content) that you have mentioned in your query because of the danger of local steroid related side effects, if overused by patients, like skin thinning, stretch marks/striae.

As itching is bothersome in fungal infections, therefore, I also ask my patients to take an OTC oral antihistamine e.g cetrizine 10 mg once daily.

Fungal infections can recur, if the conditions favorable for fungal proliferation start to exist again.
Therefore, an antifungal dusting powder e.g clotrimazole dusting powder is usually part of maintenance regime in my patients, once the condition has resolved with oral+topical antifungals.
Antifungal dusting powder keeps the folds dry as well as is inhibitory to fungal growth.

I would suggest that you visit a dermatologist in your region. Your dermatologist after examination might prescribe you an oral antifungal, if he or she feels that your condition is quite extensive to be treated by topical creams alone.

Regards
Take care

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Brief Answer:
Antifungal treatment; visit a dermatologist

Detailed Answer:
Hi.

I have gone through the images. You may continue with clotrimazole. Use it regularly, twice daily for 4 weeks.
After going through the Images, I can see there is discoloration on both inner thighs, probably due to past episodes.
I can also see a dry, slightly scaly, light coloured patch on the right inner thigh area, which is probably active Tinea. Therefore, I am of the view that you require oral antifungals. I would suggest that you visit a nearby dermatologist for a confirmatory diagnosis.

Fluconazole is given orally as a weekly dose. Some skin specialists may also give it as twice weekly dose (e.g on Wednesdays/Saturdays Or on Mondays/Thursdays) for 4-6 weeks.

Oral fluconazole is available in 150 mg and 200 mg strengths. Your doctor will decide on the duration of treatment depending on the response. Usually it is 4-6 weeks.

Antifungal steroids combinations can be considered for inflammatory Tinea (those associated with bothersome itching and burning). However, they should be used strictly under the supervision of a dermatologist and never to be used for more than 2-4 weeks.
Since in my clinical practice I find a lot of patients landing up with steroid related side effects due to topical steroid abuse, therefore I am personally not in favour of antifungal+steroid combinations. I prefer just plain antifungals. The itching part can be taken care by oral antihistamines like cetrizine.
However, if used for the prescribed duration and under the supervision of a dermatologist, an antifungal+steroid combination is ok to use.

Regards

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Brief Answer:
Thanks for the update

Detailed Answer:
Hi.

Ok. Good. What all did your dermatologist told you to use?

Regards

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Brief Answer:
Fungal infection; striae

Detailed Answer:
Hello.

Since your symptoms have definitely improved therefore you just need to stick to the treatment for a total duration of 4-6 weeks.
Symptomatic improvement is the most important criteria whether the treatment is effective or not. Usually 2 weeks is good enough time to bring about a significant symptomatic improvement but treatment must still be continued for the prescribed duration to prevent a relapse.
Thereafter you may continue with an antifungal dusting powder to prevent recurrence.

On reviewing the photographs I can also see that there are a few "striae" in the upper inner thigh area, which you probably refer to as soft area. This is most likely due to previous topical steroid use in this area (probably steroid in combination with antifungal) since you have a past history of fungal infections too.
Striae are a side effect of steroid abuse as I have mentioned in my previous reply. This is exactly the reason why I am against steroid+antifungal combination and therefore I asked you to use plain antifungal.
Striae are permanent. They wont go completely.

I can understand your frustration in dealing with this recurring problem but with regular use of the prescribed medicines you can overcome it.

Regards

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Brief Answer:
Antifungal treatment

Detailed Answer:
Hi.

Ok. You may use an antifungal+steroid combination for 2 weeks, it will provide you better symptomatic relief.
The steroid that is advisable for use at this site should be a "mild" steroid i.e beclomethasone propionate 0.05% in combination with clotrimazole. This is the only steroid that is permissible for use at this site.
You can use this combination of clotrimazole+beclomethasone propionate for a few days and thereafter change it back to plain topical antifungal (clotrimazole cream).
Clotrimazole 1% +Beclomethasone propionate 0.025% combination cream is a prescription product and you must also discuss this with your treating doctor. You must visit your doctor for a review of the skin condition.
After examining, If your doctor too feels that this combination would be better you may ask for a prescription for the same.

Rest of the treatment should be continued as before.

Regards

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Brief Answer:
Antifungal cream

Detailed Answer:
Hi

It is 0.025% Beclomethasone dipropionate. It is a mild steroid and is available in combination with Clotrimazole 1%.
I can only tell you the generic names via this forum. We cannot give a prescription online.
Please go through the disclaimer at the bottom of this page.

Regards

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