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

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?