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Allergy on middle finger post fingering, fungal infection, allergic contact dermatitis ?

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Since a few month I've an allergy on my middle finger. It firstly appeared after I fingered (sexual) my girlfriend. That time she was taking the pill. See images here: WWW.WWWW.WW
Posted Fri, 27 Apr 2012 in Skin Hair and Nails
 
 
Answered by Dr. Bharat Chawda 1 hour later
Hi! XXXXXXX

Thanks for the query,

Seeing the lesion it looks like a fungal infection(called tinea manum) rather than an allergy.There are features which are suggestive of fungal infection in your case ,as I can see in the picture that there is scaling and the cuticle of the nail is raised in one of the finger.

I would like to know few things here :
1) Is the lesion itchy ?
2) Is the other hand also involved?
3) Is there any fluid oozing from the lesion?
4) Are you using anything over the lesion and is there any response TO the treatment?
5) Does your girlfriend have any itching in her private parts?

Your girlfriend taking the pill has no relation with the lesion.If you can answer the above questions we can think of a probable diagnosis which would help in the treatment.

Hope I have answered your query, I will be available to answer your follow up queries as well.

Above answer was peer-reviewed by
 
Follow-up: Allergy on middle finger post fingering, fungal infection, allergic contact dermatitis ? 1 hour later
1.) it's itch sometimes and if it's itchy it's very itchy but I'm used not to scratch it.

2.) The other hand is also involved because I used both middle fingers.

3.) Sometimes the skin becomes wet and looks like small bubbles. When that happens it has an some output like water.

4.) The local doctors here gave me some lotions but they didn't work. Aside I'm used to disinfect my hand with alcohol but it doesn't have any positive effect.

5.) The girlfriend of mine and me separated already. As far as I remember she told me sometimes her Virgina is itchy. I also noticed that she was scratching her self there sometimes when she was as home. She wasn't that hygienic and seems to have some red parts on her body.

Thanks so far. Hope you could help me to find out what it is and how to cure it.
 
 
Answered by Dr. Bharat Chawda 8 hours later
Hi! XXXXXXX

Analyzing your history more closely , the features are going more towards a allergic reaction( what we call as ALLERGIC CONTACT DERMATITIS).The reason is that the lesion is bilateral & it oozes some times which is unlikely in a fungal infection.

Fungal infection usually manifests only in one hand ,with scaling and itching,but no oozing from the lesion.

Allergic contact dermatitis(ACD) is a chronic problem which at time responds only partly to topical creams .You mentioned taking tab cetrizine , which is a good anti allergic tablet ,but did not mention about use of any topical creams if you have used any.In fungal infection if one has used a steroid then the clinical picture completely changes .

In your case there is confusion about whether its a fungal infection or a allergic reaction. In such a case I would go the following way:
1) First discontinue all the topical cream which you are using for atleast 7 days.
2) Then get a KOH scraping done from a pathologist,which would confirm the presence of fungal infection if it comes positive.
3) If KOH scraping comes positive then take an oral broad spectrum anti fungal medicine, along with topical anti fungal creams.
4) If KOH comes negative then treat it as a allergic reaction.(i.e. topical steroids).
5) to confirm further you can also go for a skin biopsy .

Fungal infections responds good to treatment with anti fungal tablets ,but if its a allergic reaction then it may take long time to show response.

If you have any further queries ,you can write back to us.

“ Wish you Good Health”
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Follow-up: Allergy on middle finger post fingering, fungal infection, allergic contact dermatitis ? 2 days later
Good afternnon Mr Chawda,

I already stopped taking creams for more then 7 days so I went to a few hospitals and then found one pathologist. Unlucky the result is negative. She gave me a cream (Quadriderm) and some antihistamins (Loratadine Betametsone) again.

See it here:
WWW.WWWW.WW
They don't have any skin biopsy here but will look for any doctor in the other city.

Just leave a comment to the meds of the doctor and I think we can close the ticket.

I'm very thankful and guess I'm going to consult you again from time by time. What would be the best way to reach you?

 
 
Answered by Dr. Bharat Chawda 51 minutes later
Hello again,
XXXXXXX ,the Quadriderm cream prescribed to you is generally given when the doctor is not able to reach to a diagnosis .Quadriderm is a combination of four chemical .It may give you temporary relief but not solve your problem.The tablet loratidine is fine .

In such a case I would go the following way:
First stop all the creams for at-least 7 days ,then start with oral antifungal medicines (even though the KOH is negative) .Observe for at least couple of weeks to see if the lesion is responding or not.If there is a positive response then continue with the same anti fungal treatment .If the response is not good ,then start on with topical steroid creams .All this time oral anti histaminics can be given safely.

Unfortunately the link which you had sent to me is not opening .If you want you can send me again.I would say that this forum is the best way you can reach me.I may forget to see my personal XXXXXXX but not the one in XXXXXXX So if you have any further queries you can contact me .

"I wish you a speedy recovery".

regards.

Above answer was peer-reviewed by
 
Follow-up: Allergy on middle finger post fingering, fungal infection, allergic contact dermatitis ? 43 hours later
Good afternoon Dr Chawda,

The link that I've send to you just contained the same like I wrote to you.
Which medicine would you recommend for the fungal treatment and how many times should I take it in a day? Would be nice if you could provide me a name and how many times it should be taken. I prefer that you also provide me some alternatives because not all med are available here.

Just write me in detail what I should try and then I'll get it in the pharmacy. Would be also nice if you provide me also details for the topical steroid creams.

Best Regards & of cause Thanks

XXXXXXX
 
 
Answered by Dr. Bharat Chawda 44 minutes later
Hello XXXXXXX

There are various anti fungal medicines available in the market, but all are prescription based medicines. The land's law withholds us from prescribing medicines. They are not over the counter medicines. Your pharmacist would not dispense without a prescription.

We commonly use azole derivatives or terbainafins in such cases. In fungal infections you would see the result in one month ,and if not then switch over to topical steroids. You can see a GP / dermatologist is not available.

Steroids are only given for allergic conditions and not in fungal infections. Again there are various steroid creams like betamethasone ,clobetasole, mometasone etc.

I hope you understand my limitation.

Kindly avoid contact with too much of water (or gardening if you doing).
Avoid dampness.
Avoid contact with any chemical or fertilizers & detergents.
Allergy can be because of any rubber/plastic item or metals we are coming in contact with. Since allergic conditions are chronic, we should keep a watch of things we are coming in contact with (esp at work place).

I hope this guidance is of help to you .

“ Wish you Good Health”

regards,
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Follow-up: Allergy on middle finger post fingering, fungal infection, allergic contact dermatitis ? 28 hours later
Good evening doctor Chawda,

No problem at all regards your limitation because as I've thought, here in the Philippines it was sold over the counter. I just requested anti fungal and they gave me Terbinafin 1A 250mg.

How many of them should I take in a day and how many days should I take them at first?
Would it really take at least one month before I could see any result?

I'll start to take them in one week by this time the cream is almost empty and I'll wait for one week and then start to take the Terbinafin 1A 250mg.

Best Regards
XXXXXXX
 
 
Answered by Dr. Bharat Chawda 16 hours later
Hello XXXXXXX

Usually such antifungal tablets are taken daily .I would prescribe them for initial 2 weeks ,and if I see a response I would continue for another couple of weeks .But if there is no response in 2 weeks then I switch over to topical steroids. For initial two weeks avoid using any steroid creams .
If not fungal , then I would advise to take all the precautions of allergies keeping in mind what all patient would be coming in contact with.
You are lucky to get it as OTC in your country,but such medicines should be taken under dermatologists supervision & prescription.Allergic contact dermatitis is a chronic problem ,so have little patience.
I would like say here that this is my way of dealing with such cases where diagnosis is not confirmed .The best way for you would be to consult a dermatologist at your place and take his guidance too.As at times certain cream when used by patients changes the actual look of the lesion and gives a incognito picture.
I wish that you recover soon.

“ Wish you Good Health”

regards,
Dr.chawda
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Follow-up: Allergy on middle finger post fingering, fungal infection, allergic contact dermatitis ? 9 days later
Hello Dr. Chawda,

Tomorrow it’s already seven days ago that I didn’t use any cream on my hand. I also stopped taking antihistamines. So in fact I’m not taking anything this time. Since today days things got worse.

My fingers look like the way they looked before the use of the cream. The problem is this time that it spread all over my body.

My chest it fully red and has a strange rough skin, same on my left hand and also on the down of my femoral. Those skin irritations weren’t there before I took the cream and the medicine which the local dermatologist prescribed. It seems like its some side effect which appeared after quitting the cream for seven days.

The skin doesn’t have any liquid output, it’s just very itchy.
I took some pictures of myself. Hope it’s ok for you to take a look at my chest.
WWW.WWWW.WW
I’m going to start taking the Terbinafin 1A 250mg tomorrow. By this time I’ve just 3x tablets here because the pharmacy was out of stuck and wasn’t able to provide me more of those. Before I’ll start taking them I’ll buy another 11x to ensure that I could try them for two weeks.

What would be your recommendation which tablet s should I buy and try? Are the Terbinafin 1A 250mg the most effective that I can get or would you recommend me to get something else?

The local dermatologists here in my city are frustrated with my skin problems and don’t know what it caused and how to fix it so that it would be away forever. In general dermatologists here in south Philippines are not that qualified as you are.

Thanks

Best Regards
XXXXXXX
 
 
Answered by Dr. Bharat Chawda 9 hours later
Hello XXXXXXX

I think you are on the right track,even though you are getting new lesions on chest.
Unfortunately the link you have send is not opening here (probably a server problem).You can send me the picture at YYYY@YYYY .Please do wright the subject as : "ATTN Dr.Bharat Chawda" and also reply to my original answer in the website saying that you have posted the picture.
Terbinafin is a fungicidal drug (one of the best for fungus).But if you don't respond to this in 2 weeks time ,then we would discontinue it and would switch over to topical steroids.
I can understand the frustration you are facing ,but this is the best we can do.If there is itching on chest or hand lesions , you can take any anti-histaminic available at your place ,which would at-least reduce your symptoms.

I would wait for the picture and then we will discuss further.

Regards,
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Follow-up: Allergy on middle finger post fingering, fungal infection, allergic contact dermatitis ? 29 hours later
Hello Dr Chawda,

I've already mailed it to you by yesteday hope you got the mail.
By this time I see that the medicine is having some effects. The red area on my chest is getting less. So far lets see what will be the result in two weeks.

Regards

XXXXXXX
 
 
Answered by Dr. Bharat Chawda 34 minutes later
Hello XXXXXXX

I got your mail and pics. Your chest lesions seems to be different from your hand lesions. Any way its good that it is coming down.

The chest lesions seems to be an allergic reaction to (may be) a ?deodorant or ? soap . You can continue with your anti histaminics regularly.

I guess you have started anti fungal tablets; we can review and discuss about you condition after 2 weeks.

Hope to hear from you .

Regards,
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Follow-up: Allergy on middle finger post fingering, fungal infection, allergic contact dermatitis ? 2 hours later
Hello Dr. Chawda,

Thanks for mentioning soap. A few days ago my normal shampoo got empty and I exchanged it into another brand because my regular shampoo wasn't available that time. So indeed it's the shampoo.

Thanks

Surely you'll hear from me I'll keep you informed how it's going on.

Best Regards,

XXXXXXX
 
 
Answered by Dr. Bharat Chawda 5 hours later
Hello XXXXXXX

Yes it could be the soap causing the rashes on chest. You can use a mild steroid cream just for couple of days and it will go. Oral anti histaminics would also help in that.

regards
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Follow-up: Allergy on middle finger post fingering, fungal infection, allergic contact dermatitis ? 19 days later
Hello Dr. Chawda,

I'm sorry for my late reply was in HongKong for a few days and returned by now.

I've already mailed you pictures of the current state and hope you got them. Because I saw that it's working I didn't stop taking the Terbinafin 500mg. So by this time I'm taking it for 24 days without skipping any.

The left hand of mine is almost recovered while the right hand is still a little bit affected. On the left hand the skin of the nails is already fully recovered while on the right side it's still very slowly growing.

If you take a close look of the right hand pictures you could see striation / scratched but I didn't scratch it. Hmm maybe it's because there is still a fungal infection inside.

Just review it and tell me how many I should go on.

Thanks for all
Best Regards
XXXXXXX
 
 
Answered by Dr. Bharat Chawda 1 hour later
Hi XXXXXXX

Good to see that you are responding well.You have nearly taken more than half of the treatment .Since you are responding well, I would suggest you to continue it for another 3 weeks .If you experience any itching you can take tab cetrizine daily for few days .

As I saw in the picture ,your left hand has shown very good response .Your right hand still shows a bit of infection left which would respond in another couple of weeks.

I would like to review again after 2 weeks .

Regards,
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Follow-up: Allergy on middle finger post fingering, fungal infection, allergic contact dermatitis ? 32 days later
Good evening Mr. Chawda,

I wasn't able to reply you in time because I was in Hong Kong for a few days. I've already stopped taking the terbainafins for 2.5 weeks. My left hand is fully cured. But the right hand is still lightly red and the skin of the nail doesn't restore / grow.

What I also noticed that my hand has XXXXXXX rows (Image-16). I would be happy if you could advice me what to.

I'm still very thankful that you helped me to recover myself.
It would be very great if you help me to cure the remaining problems.

Hope you received my pictures
 
 
Answered by Dr. Bharat Chawda 2 days later
Hi XXXXXXX

Sorry for the delay in replying as I was not in town and could not check my XXXXXXX

I saw your pics and what I see is that there is a bit of relapse in the lesion. Also that the finger nail has not responded (since the cuticle of the nail has not formed).

I request you to take tab terbinafin (250mg) for another 2 weeks at least and then check the response before we can actually stop the treatment.

Along with this, kindly avoid excess water over the hands and also avoid it to be wet for long.

If you can get a antifungal nail laquer (paint) in any chemist shop ,then you can use it once a week for at least 6 months. This should be used all around the cuticular opening which you see at the root of the nail(where you see the folding). This laquer would help to close the opening and would avoid any water from penetration.

At other areas of palm you can use any good anti fungal creams like ketoconazole once a day.

If the nail fold doesn't get better with terbinafin alone then we might have to switch over to itraconazole or may be we have to continue terbinafin for a little longer time.

Hope this advise will help you. Kindly let me know about your condition after 2 weeks.

Wishing you a speedy recovery.

regards,
Dr.Bharat Chawda
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Follow-up: Allergy on middle finger post fingering, fungal infection, allergic contact dermatitis ? 3 days later
Hi Dr. Chawda,

Thanks for your advice I already started with what you suggested. I'll give you a report in two weeks.

Sadly there is another big issue that I've which I'm hiding for about 2 month. First it was only a small skin irritation on my left bottom after some time it also affected the right bottom and finally it affected my left and right thigh. Aside from that I just noticed that my scrota (ballbag) seem to be also a little bit red.

First I thought it's an allergy and it would disappear by its own but as I see it doesn't and I would really need your advice again what to do.

If I'm not working and not making myself busy it's very itchy (excluding the scrota). When I scratch it gets watery with a dark brown crust. I also notice is that seldom the affected areas (excluding the scrota) get’s watery even if I don’t scratchy.

I'm decided to share it because it seems like I can't cure that by my own and as usual the local doctors have no idea what it is :( I've send you some pictures and I would be very happy if you could tell me how to resolve it.

As usual I'm very thankful for your help.
Best Regards
XXXXXXX
 
 
Answered by Dr. Bharat Chawda 12 hours later
Hi XXXXXXX

Thank you for the query again and the pics.
XXXXXXX the bottom lesions seems to be a fungal infection as I can see redness with scaling.

You can continue taking the same antifungal as you have been.

You should also apply any anti fungal cream or powder over the area and try to keep it dry.

Apply the cream in the night and powder in the day time .

Kindly let me know, without any hesitation how your bottom skin is healing.

Wish you a speedy recovery.

Regards,
Dr.Bharat Chawda


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Follow-up: Allergy on middle finger post fingering, fungal infection, allergic contact dermatitis ? 1 hour later
Hi Dr. Chawda,

Thanks for your reply. Could you please recommend any powder brand or product name.

Thanks
 
 
Answered by Dr. Bharat Chawda 2 hours later
Hi again XXXXXXX

You may not get the same product as we get in our country,but you can probably find one with same content.

You can try for miconazole powder or fluconazole powder or ketoconazole powder(latest).

In cream form, ketoconazole would be best.

Regards,
Dr.Bharat Chawda
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Follow-up: Allergy on middle finger post fingering, fungal infection, allergic contact dermatitis ? 12 days later
Good evening Dr. Chawda,

I've send you already some pictures. My middle finger is already no more red and the skin on the nail is growing slowly.

When you take a look at the close-up picture of my leg you could see that the skin starts to cure slowly. It's still red but doesn't have any wet output anymore also the crust dissolved already. What I just notice is that my skin has a little bit different color. It's something like dark yellow.

Also positive is that it stopped to be very itchy. This time it’s just a little bit itchy sometimes. What I just noticed is that the infection on the legs and the bottom cures very slowly.

In fact what would be your advice? Continue the terbinafine or switch to another?

Thanks
Best Regards

XXXXXXX
 
 
Answered by Dr. Bharat Chawda 5 hours later
Hi XXXXXXX

Good to hear from you again,

I think you should continue with terbinafin for further 2 weeks. Compared to other anti fungal medicine terbinafin is fungicidal drug while others are fungi-static.

And yes the lesion on leg still looks red with scaling.

You should also use an anti fugal cream along with it. This will give a faster response .

“ Wish you Good Health”

Regards,

Dr.Bharat chawda

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Follow-up: Allergy on middle finger post fingering, fungal infection, allergic contact dermatitis ? 16 hours later
Good evening Dr. Chawda,

I'm always using "Clotrimazole Canesten (Antifungal Powder)" in combination with terbinafin and ketoconazole. I use the powder over the day and the cream at night.

Should I change anything or just keep going on the same?

Thanks

Best Regards
XXXXXXX
 
 
Answered by Dr. Bharat Chawda 18 minutes later
Hi XXXXXXX

You can continue with clotrimazole & ketoconazole as you are doing. It is good to use powder in day and cream at night and please continue with this.

All the best.

Regards,
Dr.Bharat chawda.
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Follow-up: Allergy on middle finger post fingering, fungal infection, allergic contact dermatitis ? 25 days later
Hi Dr. Chawda,

About two days ago my terbinafine tablets got empty and also my cream and powder also. I've been using the medicals for three weeks without any break. I took the medicals daily and applied the cream. The skin always was a little bit red but the itchiness was gone. The skin of my infected finger is growing but very slow.

Sadly by today the legs of my got very red again with a water output and started to get itchy again also my testicle got red again. The redness on my testicle didn’t really disappear within the three weeks. It was always there just got light red. Now it’s dark red again same as my legs.

I'm a little bit frustrated and I don't know what I should do to get rid of it.
Will be happy to get a suggestion from you what else I could try.

Thanks
Best Regards
XXXXXXX
 
 
Answered by Dr. Bharat Chawda 3 hours later
Hi! XXXXXXX

I think this problem of the testicles is different from the previous one.Over testicles one doesn't get fungal infection,and that is the reason it is not responding.Even the one which is oozing fluid ,is not a fungal infection .Fungal infections does not ooze.

This means that you have developed a allergic reaction too .

You need to apply any good steroid cream in combination with antibiotic .Please do also take a oral antibiotic tablet preferably macrolides. Topical cream can be clobetasole cream in combination with gentamycin cream. You can use this for at least 2 weeks and let me know the result. Oral Macrolides need prescription from a doctor.

For itching you can take any anti histaminic tablet.

Regards,
Dr.Chawda
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Follow-up: Allergy on middle finger post fingering, fungal infection, allergic contact dermatitis ? 39 hours later
Hi Dr. Chawda,

In Philippines almost everything is available without a prescription. The pharmacy sellers just like to profit so almost every product will be hand out over the counter. When it comes to antibiotics they are very easy available because Filipinos used to cure every sickness with antibiotics. Usually the pharmacy hands out amoxicillin. So it shouldn’t be a problem to get the macrolides.

I’m going to by the medicines by today and start taking them. Usually in the Philippines you always get prescribed antibiotics when it comes to any skin problem.

What I noticed is that since about two days the oozing fluid stopped and the color of the affected area got white on the top of the skin. As soon as I fixed my digital camera I’ll provide you some pictures of it.

Best Regards
XXXXXXX
 
 
Answered by Dr. Bharat Chawda 3 hours later
Hi! XXXXXXX

I just hope that you get the right medicines and please try to take good company product rather than the local made ones. In case you don't get Macrolides, then even amoxicillin or cloxacillin would do good.

I'll wait for the pics, that would surely help me further in guiding you better.

Regards,
Dr.Bharat chawda
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Follow-up: Allergy on middle finger post fingering, fungal infection, allergic contact dermatitis ? 1 hour later
Hi Dr Chawda,

I got the Azithromycin dihydrate Zihromax 250 mg tablet antibacterial. Also the creams:
Gentamicin garamycin 1 mg/g
clobetasol propionate dermovate 500mgcg/g.

How long should I take the Azithromycin? Also for 14 days once a day?

Best Regards
XXXXXXX
 
 
Answered by Dr. Bharat Chawda 1 hour later
Hi! XXXXXXX

You got the right medicines. Take Azithromycin for at least 3-5 days daily once. This should be taken 1 hour before food. If needed it can be repeated after 7 days of gap.

Even the creams which you got are all-right. Avoid using it on the previous area where you had fungal infection.

Wish you good health.

Regards,
Dr.Chawda
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