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This is the lesion on forearm in an 22 year old male , he was on treatment for steroid destructed fungal tenia infection what to do for this lesion

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tinea incognito AND treatment

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tinea incognito treatment topical steroid avoid dermatology guideline

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https://dermnetnz.org/topics/tinea-incognito

The lesion appears to be a small, raised, scaly-crusted, dark/violaceous plaque. It is not possible to confirm the diagnosis from a photo, and it does not look like a straightforward classic ringworm patch. Given prior steroid use, possibilities include persistent steroid-modified tinea (tinea incognito), an inflamed hair-follicle fungal infection such as Majocchi granuloma, bacterial infection, or a non-fungal inflammatory lesion.
What to do now
  1. Stop any steroid-containing cream on this lesion, including steroid-antifungal combination creams, unless a dermatologist specifically tells him otherwise. Do not abruptly stop prescribed oral steroids without the prescriber.
  2. Arrange an in-person dermatology review within a few days. Ask for a KOH skin scraping and fungal culture, ideally from the active scaly edge, before more treatment is applied. Steroid-modified tinea can lose its usual ring-like scaly border, and testing helps avoid using the wrong treatment. DermNet guidance supports stopping topical steroids and confirming with microscopy/culture.
  3. Because this is a localized lesion, a clinician may use a plain topical antifungal, but if it is deep, follicle-based, recurrent, spreading, or has not improved with correct topical therapy, it may need a prescription oral antifungal. That decision needs examination and, ideally, testing. Combination steroid-antifungal creams should be avoided because they can worsen persistence/relapse. Andrews' Diseases of the Skin, p. 347.
  4. Keep it clean and dry. Do not scratch, shave over it, cover it tightly, or share towels/clothes. Avoid home remedies, steroid creams, and antibiotic creams unless prescribed.
Seek urgent care today if it becomes rapidly larger, very painful/warm, drains pus, develops red streaks, there is fever, or the person is immunocompromised/has diabetes.
If you can provide the names/photos of the creams and tablets used, duration of treatment, whether it is itchy or painful, and whether it is enlarging, that would help assess the next step.
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