The use of a topical steroid is the most common cause. Frequently, a combination topical steroid and antifungal cream is prescribed by a physician. These combinations include betamethasone dipropionate and clotrimazole ( trade name Lotrisone) and triamcinolone acetonide and clotrimazole . In area of open skin, these combinations are acceptable in treating fungal infection of the skin. Unfortunately, in area where the skin is occluded (groin, buttock crease, armpit ), the immunosuppression by the topical steroid might be significant enough to cause tinea incognito to occur--even in the presence of an effective antifungal.
Forty-one patients with skin diseases of various origins were treated with an extempore combination of three creams containing clobetasone butyrate, sodium fusidate and ketoconazole. A mixture of the creams was applied once to 3-times daily for periods ranging from 5 to 15 days (mean days). Assessments were made before, during and at the end of the treatment period using a symptom severity rating scale. The results showed that all symptoms regressed to a significant extent and by the end of the treatment period there had been complete disappearance or improvement with satisfactory remission in % of the patients. Local tolerance was excellent or good in all patients and there were no reports of any side-effects.
Occlusive Dressing Technique
Occlusive dressings may be used for the management of psoriasis or other recalcitrant rub a small amount of cream into the lesion until it disappears. Reapply the preparation leaving a thin coating on the lesion, cover with pliable nonporous film, and seal the edges. If needed, additional moisture may be provided by covering the lesion with a dampened clean cotton cloth before the nonporous film is applied or by briefly wetting the affected area with water immediately prior to applying the medication. The frequency of changing dressings is best determined on an individual basis. It may be convenient to apply Triamcinolone acetonide cream under an occlusive dressing in the evening and to remove the dressing in the morning (., 12-hour occlusion). When utilizing the12-hour occlusion regimen, additional cream should be applied, without occlusion, during the day. Reapplication is essential at each dressing change. If an infection develops, the use of occlusive dressings should be discontinued and appropriate antimicrobial therapy instituted.