Seeking Advice on Long-Term Skin Condition Treatment

Question #28724

25 days ago

104

Seeking Advice on Long-Term Skin Condition Treatment - #28724

Omar

Medical Case Report & History Patient Profile: Male, 23 years old, Height: 160 cm, Weight: 39 kg. Case History: I have been suffering from a long-term skin condition affecting the perianal area, scrotum, and the base of the penis for about 4 years. Phase 1 (4 years ago): Based on self-diagnosis of a fungal infection, I used a topical corticosteroid (Kenacomb) intermittently for long periods (3-4 days every 2-3 months). While it provided temporary relief, it weakened the local skin immunity and masked the symptoms, leading to a condition likely resembling Tinea Incognito. Phase 2 (2 years ago): I stopped the corticosteroid and began applying large amounts of Panthenol. This caused excessive moisture (Maceration), triggering fungal activity and an intense "itch-scratch cycle." This resulted in inflammation, scaling, and bleeding (sometimes involving serous discharge) due to aggressive scratching. Phase 3 (1 year ago): Switched to Clotrimazole and Panthenol. However, the heavy, occlusive texture increased moisture and hindered absorption, leaving the pruritus (itching) unresolved. Phase 4 (5 months ago): Started using Terbinafine with a Dermactive repair cream. Although there was slight improvement, I experienced episodes of nocturnal pruritus (involuntary night scratching) that caused bleeding and reactivated the fungal infection. Phase 5 (1 month ago): Gained better control by avoiding triggers (hot water, friction, non-cotton/tight clothing). I started using Terbinafine with 5% Panthenol and Ceramides, leading to skin stabilization. Current Protocol (Started 1 week ago): Hygiene: Showering every 12 hours with lukewarm water (35°C), using Axal wash (approx. 5ml), followed by thorough drying. Treatment: Applying a thin layer of Terbinafine. Repair: Two hours later, applying Moist-1 Cica Cream (containing Cica, Arnica, and Ceramides; fragrance-free, paraben-free, and sulfate-free). Acute Itch Management: If itching intensifies, I rinse with cold water, reapply Terbinafine, and once absorbed, apply Sertaconazole powder. Current Status: Scaling has decreased by 90%, and itching is significantly reduced. I have successfully avoided scratching for 5 consecutive days. Questions for the Physician: Is the current regimen (Axal wash + Terbinafine + Moist-1 Cica) sufficient? Should I add a thin layer of 5% Panthenol for dryness, or is the Cica cream enough to repair the skin barrier without causing excess moisture? Given that the infection is chronic (2+ years) and involves the perianal, scrotal, and penile areas, which oral antifungal is most suitable for my case? What is the recommended dosage to ensure complete eradication of the infection from deeper tissues? Regarding the pinkish discoloration and skin thinning (Atrophy) caused by previous corticosteroid use: Can the skin regain its original wheatish pigment and normal thickness? What is the recommended post-treatment recovery routine?

How would you describe the severity of your itching?:

- Mild, occasional

Have you identified any specific triggers that worsen your condition?:

- Certain foods

How often do you experience flare-ups of your skin condition?:

- Rarely, less than once a month

300 INR (~3.53 USD)

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Doctors' responses

Dr. Arsha K Isac

I am a general dentist with 3+ years of working in real-world setups, and lemme say—every single patient teaches me something diff. It’s not just teeth honestly, it’s people… and how they feel walking into the chair. I try really hard to not make it just a “procedure thing.” I explain stuff in plain words—no confusing dental jargon, just straight talk—coz I feel like when ppl *get* what's going on, they feel safer n that makes all the difference. Worked with all ages—like, little kids who need that gentle nudge about brushing, to older folks who come in with long histories and sometimes just need someone to really sit n listen. It’s weirdly rewarding to see someone walk out lighter, not just 'coz their toothache's gone but coz they felt seen during the whole thing. A lot of ppl come in scared or just unsure, and I honestly take that seriously. I keep the vibe calm. Try to read their mood, don’t rush. I always tell myself—every smile’s got a story, even the broken ones. My thing is: comfort first, then precision. I want the outcome to last, not just look good for a week. Not tryna claim perfection or magic solutions—just consistent, clear, hands-on care where patients feel heard. I think dentistry should *fit* the person, not push them into a box. That's kinda been my philosophy from day one. And yeah, maybe sometimes I overexplain or spend a bit too long checking alignment again but hey, if it means someone eats pain-free or finally smiles wide in pics again? Worth it. Every time.

24 days ago

Helloo
Your current routine is appropriate and the improvement you describe suggests the infection is now well-controlled. Using an antifungal like Terbinafine regularly plus gentle hygiene is usually sufficient for chronic groin/perianal fungal infections such as Tinea incognito. The Cica cream with ceramides is generally enough for barrier repair; adding extra 5% panthenol is optional only if you feel dryness or tightness—avoid thick or frequent layering because excess moisture can trigger recurrence.
For long-standing or deep infections, oral antifungals sometimes used include Itraconazole or Fluconazole, but the exact drug and dose must be chosen by a doctor after examination and possibly a fungal test. This is especially important in your case because your weight (39 kg) is significantly below average for a 23-year-old male, so standard adult dosing may need adjustment.
Yes, steroid-related thinning and pink discoloration from previous use of Kenacomb usually improves gradually once steroids are stopped; pigment and thickness often recover over 3–12 months if friction and infection are controlled. Continue gentle care: lukewarm water, full drying, loose cotton underwear, and continue antifungal treatment for at least 2–4 weeks after symptoms fully disappear to prevent relapse.
Overall severity now appears mild and improving, and your current regimen (Axal wash + Terbinafine + Cica moisturizer, with occasional powder like Sertaconazole if sweating) is reasonable. If itching, scaling, or redness persists beyond another 2–3 weeks, or if lesions spread, a dermatologist visit for skin scraping and possible oral therapy would be the next step. 👍
Regards
Take care

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Dr. Bharat Joshi

I’m a periodontist and academician with a strong clinical and teaching background. Over the last 4 years and 8 months, I’ve been actively involved in dental education, guiding students at multiple levels including dental hygienist, BDS, and MDS programs. Currently, I serve as a Reader at MMCDSR in Ambala, Haryana—a role that allows me to merge my academic passion with hands-on experience. Clinically, I’ve been practicing dentistry for the past 12 years. From routine procedures like scaling and root planing to more advanced cases involving grafts, biopsies, and implant surgeries. Honestly, I still find joy in doing a simple RCT when it’s needed. It’s not just about the procedure but making sure the patient feels comfortable and safe. Academically, I have 26 research publications to my credit. I’m on the editorial boards of the Archives of Dental Research and Journal of Dental Research and Oral Health, and I’ve spent a lot of time reviewing manuscripts—from case reports to meta-analyses and even book reviews. I was honored to receive the “Best Editor” award by Innovative Publications, and Athena Publications recognized me as an “excellent reviewer,” which honestly came as a bit of a surprise! In 2025, I had the opportunity to present a guest lecture in Italy on traumatic oral lesions. Sharing my work and learning from peers globally has been incredibly fulfilling. Outside academics and clinics, I’ve also worked in the pharmaceutical sector as a Drug Safety Associate for about 3 years, focusing on pharmacovigilance. That role really sharpened my attention to detail and deepened my understanding of drug interactions and adverse effects. My goal is to keep learning, and give every patient and student my absolute best.

24 days ago

Hello dear
See self diagnosis and associated medication can cause irritation and discomfort.
Probably your clinical condition has not healed because of improper regimen.
Iam suggesting some medication and precautions
Please follow them for atleast two weeks
Topical Antifungals powders-Clotrimazole-	Candid/clomed/clozed twice a day for 15 days
Micogel to be applied topically
Nizoral	 for Skin application
Terbinafine	250 mg twice a day for 5 days ( oral)
addition
Apply lulliconazole or fusidic acid topical application twice a day for 5 days
Prevent moisture contamination
Dry the involved organ
In case of no improvement consult general physician (medicine) for better clarity
Hopefully you recover soon
Regards

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Dr. Nikhil Chauhan

I am currently working as a urologist and kidney transplant surgeon at Graphic Era Medical College & Hospital, Dehradun. It's a role that keeps me on my toes, honestly. I handle a pretty wide range of urology cases—stones, prostate issues, urinary tract obstructions, infections, you name it. Some are straightforward, others way more complex than you expect at first glance. Every patient walks in with a different story and that’s what keeps the work real for me. Kidney transplant surgery, though, that’s a whole different zone. You’re not just working on anatomy—you’re dealing with timelines, matching, medications, family dynamics, emotional pressure... and yeah, very precise coordination. I’m part of a team that manages the entire transplant process—from evaluation to surgery to post-op care. Not gonna lie, it’s intense. But seeing someone who’s been on dialysis for years finally get a new shot at life—there’s nothing really like that feeling. In the OR, I’m detail-focused. Outside of it, I try to stay accessible—patients don’t always need answers right away, sometimes they just need to feel heard. I believe in walking them through what’s going on rather than just giving reports and instructions. Especially in transplant cases, trust matters. And clear, honest conversation helps build that. Urology itself is such a misunderstood field sometimes. People ignore symptoms for years because it feels “awkward” or they think it’s not serious until it becomes unmanageable. I’ve had patients who came in late just because they were embarassed to talk about urine flow or testicular pain. That’s why I also try to make the space judgment-free—like whatever it is, we’ll figure it out. At the end of the day, whether I’m scrubbing in for surgery or doing OPD rounds, I just want to make sure what I do *actually* helps. That the effort’s not wasted. And yeah, some days are frustrating—some procedures don’t go clean, some recoveries take longer than they should—but I keep showing up, cause the work’s worth doing. Always is.

24 days ago

Hi Omar,
Thank you for sharing such a detailed and well-structured history. Your insight into your own condition is impressive, and your current progress—especially 5 days scratch-free—is a significant milestone.
Here are crisp, point-wise answers to your questions:
1. Current Regimen (Axal wash + Terbinafine + Moist-1 Cica)
· Yes, it is sufficient.
· Axal wash (likely antifungal/antibacterial) is appropriate for hygiene without over-drying.
· Terbinafine is effective for dermatophytes; continue as directed (usually 1–2 weeks after symptoms resolve).
· Cica cream is enough—it provides barrier repair without occlusion.
· Skip additional Panthenol for now; layering may reintroduce maceration risk.
2. Oral Antifungal
· Given chronic (>2 years), extensive involvement (perianal, scrotal, penile), and risk of deeper tissue involvement, oral terbinafine or itraconazole are preferred.
· Typical dose:
· Terbinafine: 250 mg once daily for 4–6 weeks (may extend if needed).
· Itraconazole: 100–200 mg daily or pulsed dosing (e.g., 1 week/month for 2–3 months).
· Must be prescribed after clinical confirmation (fungal scraping/culture ideal) and baseline LFTs.
3. Skin Thinning (Atrophy) & Pigment Changes
· Yes, improvement is possible but takes time (months to over a year).
· Recovery tips:
· Continue ceramide-based barrier repair (Cica cream is good).
· Strict sun protection (UV worsens atrophy and dyspigmentation).
· Avoid any topical steroid unless absolutely necessary and under supervision.
· Once infection clears, topical calcineurin inhibitors (tacrolimus/pimecrolimus) can help residual inflammation and pigmentation without steroid risks.
Summary
· You’re on the right track.
· Add oral antifungal for full clearance.
· Barrier repair + time will improve atrophy and pigmentation.
· Avoid adding occlusive layers.
You’ve shown excellent discipline—this is what leads to lasting recovery.
Dr. Nikhil Chauhan

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Dr. Shayeque Reza

I completed my medical degree in 2023, but honestly, my journey in healthcare started way before that. Since 2018, I’ve been actively involved in clinical practice—getting hands-on exposure across multiple departments like ENT, pediatrics, dermatology, ophthalmology, medicine, and emergency care. One of the most intense and defining phases of my training was working at a District Government Hospital for a full year during the COVID pandemic. It was chaotic, unpredictable, and exhausting—but it also grounded me in real-world medicine like no textbook ever could. Over time, I’ve worked in both OPD and IPD setups, handling everything from mild viral fevers to more stubborn, long-term conditions. These day-to-day experiences really built my base and taught me how to stay calm when things get hectic—and how to adjust fast when plans don’t go as expected. What I’ve learned most is that care isn't only about writing the right medicine. It’s about being fully there, listening properly, and making sure the person feels seen—not just treated. Alongside clinical work, I’ve also been exposed to preventive health, health education, and community outreach. These areas really matter to me because I believe real impact begins outside the hospital, with awareness and early intervention. My approach is always centered around clarity, empathy, and clinical logic—I like to make sure every patient knows exactly what’s going on and why we’re doing what we’re doing. I’ve always felt a pull towards general medicine and internal care, and honestly, I’m still learning every single day—each patient brings a new lesson. Medicine never really sits still, it keeps shifting, and I try to shift with it. Not just in terms of what I know, but also in how I listen and respond. For me, it’s always been about giving real care. Genuine, respectful, and the kind that actually helps a person heal—inside and out.

24 days ago

Your long-standing condition is most consistent with a chronic fungal infection (tinea cruris/tinea incognito) complicated by prior steroid use, moisture-related maceration, and a prolonged itch–scratch cycle, and your current improvement indicates that your present regimen (gentle cleansing, topical antifungal like Terbinafine, and barrier repair with a ceramide-based cream) is largely appropriate and effective; continued consistent use with strict moisture and friction control is key, while excessive layering (including additional panthenol) should be avoided if the skin is already stable to prevent maceration, and given the chronicity and anatomical involvement, a short course of oral antifungal (such as terbinafine or itraconazole under medical supervision) may be considered if topical therapy alone fails to fully clear the infection, and regarding steroid-induced skin thinning and discoloration, gradual recovery is possible over time with proper barrier repair and avoidance of steroids, although pigmentation may take months to normalize, making long-term maintenance and gentle skin care essential for full recovery

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Dr. Prasannajeet Singh Shekhawat

I am a 2023 batch passout and working as a general physician right now, based in Hanumangarh, Rajasthan. Still kinda new in the bigger picture maybe, but honestly—every single day in this line teaches you more than textbooks ever could. I’ve had the chance to work under some pretty respected doctors during and after my graduation, not just for the clinical part but also to see how they handle people, real people, in pain, in panic, and sometimes just confused about their own health. General medicine covers a lot, right? Like from the smallest complaints to those random, vague symptoms that no one really understands at first—those are kinda my zone now. I don’t really rush to label things, I try to spend time actually listening. Feels weird to say it but ya, I do take that part seriously. Some patients just need someone to hear the whole story instead of jumping to prescription pads after 30 seconds. Right now, my practice includes everything from managing common infections, blood pressure issues, sugar problems to more layered cases where symptoms overlap and you gotta just... piece things together. It's not glamorous all the time, but it's real. I’ve handled a bunch of seasonal disease waves too, like dengue surges and viral fevers that hit rural belts hard—Hanumangarh doesn’t get much spotlight but there’s plenty happening out here. Also, I do rely on basics—thorough history, solid clinical exam and yeah when needed, investigations. But not over-prescribing things just cz they’re there. One thing I picked up from the senior consultants I worked with—they used to say “don’t chase labs, chase the patient’s story”... stuck with me till now. Anyway, still learning every single day tbh. But I like that. Keeps me grounded and kind of obsessed with trying to get better.

24 days ago

Hello
You’re making great progress—90% less scaling and much less itching is a good sign! Here’s a clear summary and guidance for your questions:
### 1. Is your current regimen enough?
- Axal wash + Terbinafine + Moist-1 Cica is a solid routine for fungal infections and skin repair. If your skin feels dry, adding a thin layer of 5% Panthenol (a skin-soothing ingredient) is safe and can help with hydration and barrier repair. However, if Moist-1 Cica is already keeping your skin comfortable and not too moist, you don’t need to add more. Too much moisture can sometimes slow healing or encourage fungal growth.
### 2. Oral antifungal for chronic infection
- For chronic, widespread fungal infection (especially in perianal, scrotal, and penile areas), oral terbinafine or oral itraconazole are commonly used. Both penetrate deeper tissues well.
- Terbinafine is usually preferred for dermatophyte infections (like tinea cruris), but only a doctor can prescribe and decide the right dose and duration for you. Typical courses are 2–4 weeks, but chronic cases may need longer.
- Do not self-medicate or adjust doses yourself. Always check with your doctor for the safest and most effective plan.
### 3. Skin atrophy and discoloration from steroids
- Skin thinning and pinkish discoloration from steroid use can improve over time, but full recovery may take months. The skin can regain its normal thickness and pigment, especially if you avoid further steroid use and protect the area.
- Post-treatment recovery routine:
- Continue gentle moisturizers (like Cica or Panthenol).
- Avoid harsh soaps, scrubbing, and further steroid creams.
- Protect the area from friction and sun exposure.
- Consider using a mild sunscreen if the area is exposed.
### 4. When to see your doctor
- If the infection persists, recurs, or you notice new symptoms (pain, pus, fever), follow up with your dermatologist for oral medication and monitoring.
Bottom line: Your current regimen is good, Panthenol can be added if needed, but don’t over-moisturize. Oral antifungal choice and dose must be decided by your doctor. Skin atrophy usually improves, but patience and gentle care are key.
Thank you

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Dr. Aarav Deshmukh

I am a general physician with 8 years of practice, mostly in urban clinics and semi-rural setups. I began working right after MBBS in a govt hospital in Kerala, and wow — first few months were chaotic, not gonna lie. Since then, I’ve seen 1000s of patients with all kinds of cases — fevers, uncontrolled diabetes, asthma, infections, you name it. I usually work with working-class patients, and that changed how I treat — people don’t always have time or money for fancy tests, so I focus on smart clinical diagnosis and practical treatment. Over time, I’ve developed an interest in preventive care — like helping young adults with early metabolic issues. I also counsel a lot on diet, sleep, and stress — more than half the problems start there anyway. I did a certification in evidence-based practice last year, and I keep learning stuff online. I’m not perfect (nobody is), but I care. I show up, I listen, I adjust when I’m wrong. Every patient needs something slightly different. That’s what keeps this work alive for me.

23 days ago

Your current regimen is quite comprehensive, but let’s address a few key aspects more precisely. Adding 5% Panthenol could introduce additional moisture, so it’s wise to proceed with caution. Cica cream alone might be sufficient for barrier repair without risking maceration. Observe your skin’s response closely; if you notice increased moisture or irritation, consider reducing the frequency of Panthenol application.
For chronic fungal infections, especially given the duration and location, an oral antifungal could be necessary. Terbinafine is often recommended for dermatophyte infections, but fluconazole or itraconazole may also be suitable, depending on the exact type of fungus. It’s essential to consult with a dermatologist to identify the specific pathogen through culture tests—they can guide appropriate treatment. Dosage typically involves a 2- to 4-week course for skin infections, with specific regimens varying based on the medication chosen and your unique needs.
As for the discoloration and thinning from corticosteroid use, skin recovery can be gradual. Reducing inflammation and promoting healing with ceramide-containing products, as you are doing, is beneficial. Limiting UV exposure and applying sunscreen can help prevent further pigmentation changes. If you’re concerned about atrophy, a dermatologist might suggest specific treatments like niacinamide for pigmentation or retinoids to help normalize skin thickness, but these require careful monitoring due to sensitivity in the affected areas. Consulting your healthcare provider for a regular follow-up is essential to tailor treatments appropriately and ensure healing progresses safely.

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