Brief Answer:
Fungal infection; oral+topical antifungals

Detailed Answer:
Hello XXXX.

Thanks for writing to us at healthcaremagic

Fungal Infection of the groin folds or Tinea Cruris is quite prevalent and the problem is even more common specially if one is living in cities like XXXXXXX which have high humidity.
The moist, humid conditions that prevail in the folds, specially in hot and humid weather, encourages fungal growth.
Tinea cruris classically presents as annular patches with scaly, red, raised margins and central clearing. Itching is bothersome.

One of the other most common reasons for recurrence is inadequate treatment. I could gather from your treatment history that the last time you were on antifungal treatment 2 months ago, you used oral as well as topical terbinafine for just a week, which is grossly inadequate.
The normal recommended duration of treatment is 4-6 weeks.

The problem of recurrence has been further compounded by reports of resistance to increasing number of antifungals like, fluconazole as well as terbinafine.

One important step in preventing a recurrence, after an apparently complete cure, is to continue using an antifungal dusting powder (containing either clotrimazole, fluconazole or terbinafine) in the groin folds; specially during hot and sweaty weather conditions.
Antifungal dusting powder not only keeps the folds dry but also being antifungal, they inhibit fungal growth/proliferation.

One more point I want to make is that chronic scratching of the affected skin causes the skin to become thick and dark; this condition is known as Lichen Simplex Chronicus (LSC), which itself is an itchy condition.
In LSC the more you scratch the more the skin itches thus it forms a cycle (itch-scratch-itch cycle) which is self perpetuating.
This condition needs to be ruled out in you on examination; treatment is with topical steroids and oral antihistamines.

If I was the treating doctor I would suggest you to take a repeat course of terbinafine (oral+topical) for 4-6 weeks and thereafter continue with an antifungal dusting powder to prevent a recurrence.

An OTC oral antihistamine e,g cetrizine would provide you symptomatic relief from itching.

Another alternative, if terbinafine proves to be ineffective or not as effective as expected, is to try a different antifungal e.g Itraconazole. There is not much of a problem of fungal resistance with Itraconazole, as of now.

I would suggest that you also discuss in more detail about these points with your treating dermatologist.
The most important part of treatment is to be complaint with the prescribed treatment (oral and topical) and to take it for the recommended duration.

Kindly upload a picture of the white spot that you have recently noticed on your penis.

regards

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Brief Answer:
Visit a dermatologist in your region

Detailed Answer:
Dear XXXX. My job here is to give you treatment options and give you pointers in the right directions, so that you are benefited from the information I provide.

It would be unethical on my part to prescribe you the brand names Or dosage of the medicines via this forum, because actually I have not had the opportunity to examine you. I can only provide you the generic names via this forum.

Itraconazole is a prescription drug. Apart from clotrimazole dusting powder, other antifungal dusting powders that are available in the market contain either terbinafine Or fluconazole. They are also prescription products and are not available OTC.

A visual assessment is the best way to judge before we can prescribe medicines. A dermatologist in your region would be able to examine you in person and would be in a better position to prescribe you the brand names.

Please go through the disclaimer at the bottom of the page.

Regards

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Brief Answer:
Restart terbinafine (oral+topical)

Detailed Answer:
Hi

If I were to treat a case such as you, my general advice would have been to be complaint with the treatment till the total recommended duration of treatment.
After going through your treatment history,it is obvious to me that the last time you were on antifungal treatment (that was 2 months ago), you were on oral as well as topical terbinafine but you used it for just a week!! which is grossly inadequate.
The normal recommended duration of treatment is 4-6 weeks for both oral as well as topical terbinafine.
I guess you showed signs of improvement within a week and then you stopped it. So considering that, I think you should restart terbinafine and take it for the recommended duration of treatment i.e 4-6 weeks.

Itraconazole is an option, that can always be tried later on. It is not a first choice antifungal because it is fungistatic (inhibits fungus); in contrast, terbinafine is fungicidal (kills fungus). Therefore the chances of relapse are lesser with terbinafine.
Itraconazole is a reserve drug for treatment of dermatophytic infections (tinea cruris) in those cases who possibly have resistance to terbinafine. However, itraconazole works very well for candidal infections (paronychia Or nail fold infections and candidal balanoposthitis) and vice versa for terbinafine.

So the choice of antifungal depends on the condition to be treated, which is terbinafine (oral+topical) in your case.

You may ask for a renewed prescription of terbinafine from your doctor. Terbinafine antifungal dusting powder would be useful for maintenance of improvement.

Regards

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