Brief Answer:
Tinea cruris+Cnadidal balanitis

Detailed Answer:
Hello and Welcome to healthcaremagic

I am Dr. Kakkar. I have gone through your query.

I would keep a possibility of Tinea Cruris along with Candidal balanoposthitis.

Tinea cruris can be recurrent:-
--In the presence of predisposing factors(underlying diabetes;Obese individuals; hot,humid condition etc)
--If the treatment is taken irregularly or incompletely(most likely factor in your case), regular treatment last for 4- 6 weeks.
--Sometimes due to constant scratching an element of eczema sets in and the skin becomes lichenified (thickened) which itself is an itchy condition and thus it becomes a cycle, the more you scratch the more it itches and the more is the desire to scratch (Itch Scratch Cycle)
--Sometimes if the fungus is resistant to the oral antifungal. Azoles like Fluconazole, Clotrimazole are fungistatic (inhibits fungal growth) therefore it does'nt kill the fungus; that may be one of the factors for recurrence especially in hot, humid conditions when the fungus gets a chance to re-proliferate.

As a treating dermatologist i usually ask my patients to take Terbinafine which is fungicidal(kills fungus). Topical treatment is a useful adjuvant to oral treatment.

In my practice i find good results with topical terbinafine cream for 2-4 weeks. It should be used regularly, twice daily for 4-6 weeks so as to achieve mycological cure, even if the skin condition improves (clinical cure). Clinical cure is earlier, the aim of treatment is to achieve mycological cure (which takes 4-6 weeks)

In addition to topical cream, using an antifungal dusting powder (Clotrimazole dusting powder e.g Abzorb dusting powder) regularly, keeps the area dry and does'nt allow the fungus to proliferate again.

An oral antihistamine like cetrizine once daily, helps with the itch part.

General measures like bathing twice daily and wearing loose cotton undergarments and loose fitting clothes also help. Predisposing factors if present like diabetes, obesity need to be addressed too.

Regarding candidal balanoposthitis, I would suggest topical application a topical antifungal+ topical steroid combination cream, twice daily for 7 days e.g Clotrimazole + baclomethasone cream (Clotrin-B cream) along with a Single Dose of Tab . Fluconazole 150 mg, stat.)

Use just plain water to clean up this area. Use of soaps is not advisable here.

I would suggest a test for Blood sugar.

Hope this helps.
Take care
Regards

---

Brief Answer:
Upload a better photograph with clarity

Detailed Answer:
Hi.

To summarize:

For Groins:
-Tab. Terbinafine 250 mg once daily (Tab. Zimig 250mg) for 4-6 weeks along with terbinafine cream (Zimig cream) twice daily for 4-6 weeks. Tab terbinafine is a prescription medicine and should be taken after consultation with a dermatologist.
-Tab cetrizine 10 mg once daily for symptomatic itch relief.
-Thereafter use an antifungal dusting powder (clotrimazole dusting powder) for maintenance.

For penile head:
I would keep a likely possibility of 'Candidal balanoposthitis'. However, I would like to rule out 'Herpes genitalis'. Since the image is blurred, therefore I request you to upload a good clarity photograph for confirmation.

For candidal balanoposthitis, I normally recommend topical application of Clotrimazole + beclomethasone cream (Clotrin-B cream), twice daily for 7 days.

Use just plain water to clean up this area. Use of soaps is not advisable here.

Regards

---

Brief Answer:
Herpes genitalis+Candidal balanitis

Detailed Answer:
Hi.

I have reviewed the photographs.

This looks like a case of "Herpes Genitalis with superimposed Candidal Balanitis".

I would suggest a blood test for herpes (HSV ELISA, IgG and IgM). If it is positive then I would suggest you to add an antiviral medication e.g "Tab. Valcyclovir 500 mg three times a day for 7 days". It is to be taken under supervision of a doctor.

Topically you may use an antibacterial cream e.g Fucidin cream (contains fusidic acid) instead of Clotrin-B cream, which I mentioned earlier.

Orally you may take a "Single dose of Tab. Fluconazole 150 mg", just for today.

Yes terbinafine is ok with your other medicines.

Regards

---

Brief Answer:
STD testing

Detailed Answer:
Hi.

It is not serious but it is a standard routine practice to undergo STD testing, once in a while, especially if you have multiple partners, even if you use a protection.

Moreover, since I have kept a possibility of herpes genitalis, therefore i asked you to undergo a test for HSV ELISA.

Regards

---