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You are family senior most dermatologist she give best medice possible that help to get rid of problem

I'd be glad to help as a dermatology consultant, but I need to know what skin problem you're dealing with before I can recommend anything. Please tell me:
  1. What's the issue? - e.g. acne, rash, itching, dark spots, dryness, hair loss, fungal infection, eczema, allergic reaction, etc.
  2. Where on the body, and how long has it been going on?
  3. What does it look like? - color, size, raised/flat, blisters, scaling, pus, pain, itch
  4. Any triggers (new products, food, weather, stress) or other symptoms (fever, swelling)?
  5. Any allergies or medications you're currently on?
If you have a photo of the affected area, you can upload it too - that helps a lot with an accurate assessment.
Once I know the specifics, I'll walk through likely causes and the best treatment options (topical or oral) safely.

My mom is 42 y old working in hotel where she gets her almost wet everytime while working she started having itching since 2 years Where she tried some steroids they worked for few months then after she started experiencing the issue again now when I see the problem I prescribed luliconozel which is antifungal cream while using the cream she gets rid of itching for itching then again she is facing the same issue so I want the best medicine possible to work for legs where she can't leave her works due to financial problem we consulted some dermatologist but the issue not going so I have full trust in for recommending the best medicine

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Searching PubMed

"Trichophyton indotineae" AND terbinafine resistance

Searching the Web

recalcitrant tinea India treatment guidelines 2024 itraconazole terbinafine resistant dermatophytosis

Likely Diagnosis

This pattern is very characteristic of chronic/recurrent tinea cruris–corporis (fungal infection) modified by earlier steroid use ("tinea incognito"), now behaving as recalcitrant dermatophytosis - a well-documented, epidemic-level problem in India right now.
Why it keeps relapsing:
  • Steroid use early on suppressed inflammation and itching without killing the fungus, which let it spread quietly under normal-looking skin (tinea incognito) - Dermatology 2-Volume Set 5e; Red Book 2021.
  • Luliconazole alone helps symptoms but often isn't enough once an infection has become chronic/recalcitrant - itching resolving is not the same as the fungus being eradicated. Many people stop the cream as soon as itching stops, which is the single biggest cause of relapse.
  • Constant wetness from her job keeps the skin macerated and warm - the ideal environment for dermatophytes to persist and reinfect, so topical treatment keeps getting "outrun" by the environment.
  • India is currently seeing a rise in terbinafine-resistant Trichophyton indotineae strains, which is why plain topical/oral terbinafine sometimes fails where it used to work - PMID 39927724, PMID 37432126.

What actually works for this pattern (Indian dermatology consensus - ITART/ECTODERM guidelines)

For recalcitrant tinea like this, oral antifungal therapy combined with topical treatment is now the standard, not topical cream alone:
  1. Oral itraconazole 200 mg/day (100 mg twice daily, taken right after a meal, ideally with a fizzy/acidic drink for absorption) for 4-6 weeks. This is currently preferred first-line in India over terbinafine because of resistance concerns, and a large Indian RCT (JAMA Dermatol 2022, Khurana et al.) confirmed good cure rates with this regimen.
    • Alternative: oral terbinafine 250 mg/day for 4-6 weeks, if itraconazole isn't suitable.
  2. Keep using the topical antifungal (luliconazole 1% once daily) alongside the oral drug, and continue it for 2 weeks after the skin looks completely clear - not just until itching stops.
  3. Never use any steroid-containing cream on this again - combination creams (steroid + antifungal, sold widely over-the-counter in India) are the main driver of these relapsing, spreading cases. This point is strongly emphasized in the IADVL Task Force consensus.
  4. Apply cream over the visible rash plus about 2-3 cm of normal-looking skin around it - the fungus often extends beyond what's visibly inflamed.
Because oral antifungals need a basic safety check (liver function test before starting, since both itraconazole and terbinafine are processed by the liver) and because she's already failed multiple rounds of treatment, she should get this prescribed and monitored by a doctor in person rather than self-medicating - but the treatment principle above is what you should specifically ask the dermatologist about, since it's what current guidelines recommend for exactly her situation.

Practical steps for her work environment (this matters as much as the medicine)

  • Carry a change of dry socks/clothing and change out of wet clothing/footwear as soon as feasible during breaks.
  • Dust affected areas with an antifungal powder (e.g., clotrimazole/miconazole powder) during work hours to help keep skin dry - this is a simple, work-compatible addition.
  • Wash and sun-dry (or hot-iron) any clothing, towels that touch the area regularly; don't share towels.
  • Check her feet and nails too - untreated athlete's foot or nail fungus is a common hidden reservoir that keeps reinfecting the legs even after the leg rash clears.
  • Loose, breathable (cotton) clothing where the uniform allows it.

One caution

If after a proper 4-6 week course of oral therapy done correctly (right dose, right duration, no steroids mixed in) it still doesn't clear, that raises suspicion of a resistant strain, and the dermatologist may want a KOH scraping/fungal culture to confirm the diagnosis and guide drug choice rather than continuing to cycle through creams empirically.
Sources: Dermatology 2-Volume Set 5e; Red Book 2021 (Committee on Infectious Diseases); Fitzpatrick's Dermatology; Goodman & Gilman's Pharmacological Basis of Therapeutics; Katzung's Basic and Clinical Pharmacology; IADVL Task Force Against Recalcitrant Tinea (ITART) and ECTODERM India consensus statements; Khurana A et al., JAMA Dermatol 2022;158(11):1269-78; recent resistance data (PMID 39927724, 37432126).
This is guidance to bring to her doctor, not a substitute for an in-person exam and blood work before starting oral medication - especially given how many rounds of treatment have already failed.
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