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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest Treatment For Contact Dermatitist

Hi, I am suffering from severe contact dermatitis medicamentosa in my anal region. This condition was triggered by an ingridient found in one of the two hemmorroids topical treatments (Proctosedyl and Doloproct) prescribed by my doctor. As the condition worsened, other failed treatments my doctor prescribed were Hydrocortisyl cream 1%, Dermovate ointment and E45 cream. When my doctor couldn't cure my worsening condition he referred me to a dermatologist who prescribed a course of Prednisolone 5mgs tablets for 12 days and to smear Vaseline petroleum jelly on my anal region. Initially, I did well with the Prednisolone but as I was nearing the latter half of the tablet treatment the condition started to relapse. Also, any wash prescribed by both the doctor and the dermatologist gave me no relief at all (I actually felt them make my skin burn more). I have also used a very weak permanganate solution as a wash but that didn’t offer me any relief and using water on its own seemed / felt better. Currently, the skin in my anal region is dry, pinkish/reddish and is constantly burning. I have been constantly suffering immensely for 2 months now and I would like to know if you can recommend some other form of treatment as anything that has been prescribed to date has either not worked at all or made the condition worse. Thanks.
Mon, 10 Nov 2014
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Dermatologist 's  Response
Hello. Thanks for writing to us at healthcaremagic

Judging from the history and the treatments tried, which seems to benefit the condition only temporarily; I would keep a possibility of "Intertrigo", which is inflammation of the body folds (red and sore folds).
Closely opposing body folds can trap moisture and therefore make the area prone to Inflammation from rubbing against each other.
Candidal infection may superimpose (Candidal Intertrigo) thus exacerbating the inflammation (redness and soreness) and itching.
Clinically intertrigo Or candidal intertrigo presents as red, moist, scaly patches of skin on closely opposed body folds.

If I was the treating doctor I would have started you on oral antifungals e.g Oral Fluconazole, in addition to the topical (antifungals+steroids) creams that you have been using already.
Oral antifungals are faster acting and much better in controlling candidal superinfection. Oral antifungals are prescription drugs.

Once the condition improves significantly (usually within 2-4 weeks), what I do in my patients of Intertrigo is, I then ask them to use an antifungal dusting powder e.g clotrimazole dusting powder in the folds, twice daily, for maintenance of improvement.
An antifungal dusting powder not only keep the area dry but also inhibits the growth of fungus/yeast thus preventing recurrence/exacerbation of Intertrigo.

It would be better if you present yourself for examination to a dermatologist. Your dermatologist would tell you more about this condition and prescribe accordingly.

Hope this helps
Take care
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Suggest Treatment For Contact Dermatitist

Hello. Thanks for writing to us at healthcaremagic Judging from the history and the treatments tried, which seems to benefit the condition only temporarily; I would keep a possibility of Intertrigo , which is inflammation of the body folds (red and sore folds). Closely opposing body folds can trap moisture and therefore make the area prone to Inflammation from rubbing against each other. Candidal infection may superimpose (Candidal Intertrigo) thus exacerbating the inflammation (redness and soreness) and itching. Clinically intertrigo Or candidal intertrigo presents as red, moist, scaly patches of skin on closely opposed body folds. If I was the treating doctor I would have started you on oral antifungals e.g Oral Fluconazole, in addition to the topical (antifungals+steroids) creams that you have been using already. Oral antifungals are faster acting and much better in controlling candidal superinfection. Oral antifungals are prescription drugs. Once the condition improves significantly (usually within 2-4 weeks), what I do in my patients of Intertrigo is, I then ask them to use an antifungal dusting powder e.g clotrimazole dusting powder in the folds, twice daily, for maintenance of improvement. An antifungal dusting powder not only keep the area dry but also inhibits the growth of fungus/yeast thus preventing recurrence/exacerbation of Intertrigo. It would be better if you present yourself for examination to a dermatologist. Your dermatologist would tell you more about this condition and prescribe accordingly. Hope this helps Take care