26 years female 3rd month amenorrhea (pregnancy), known diabetic, pregnant after 10 years (PRIMI), itching rounded patch on anterior aspect thigh since 4 months. History of using different types of creams . And consulted many doctors. But no use. 1) What is the diagnosis? 2) DD? 3) What are the precautions to take for pregnancy during treatment, 4) How to manage this patient?



1 ) Dx :- Tinea incognito. 2 ) D / D :- Tinea corporis 3 ) Precautions on the part of the mother :- For the best prenatal care, assemble a team that includes the following: 1 ) A doctor, trained to care for people with diabetes, who has cared for pregnant women with diabetes 2 ) An obstetrician who handles high-risk pregnancies and has cared for other pregnant women with diabetes 3 ) A pediatrician (children's doctor) or neonatologist (doctor for newborn babies) who knows and can treat special problems that can happen in babies of women with diabetes 4 ) A registered dietitian who can change your meal plan as your needs change during and after pregnancy. 5 ) A diabetes educator who can help you manage your diabetes during pregnancy. Its important to remember that YOU are the leader of your health care team. Keep track of any questions you have and make sure to ask your health care team. 6 ) During pregnancy, your diabetes control will require more work. The blood glucose checks you do at home are a key part of taking good care of yourself and your baby before, during and after pregnancy. Blood glucose targets are designed to help you minimize the risk of birth defects, miscarriage and help prevent your baby from getting too large. If you have trouble staying in your target range or have frequent low blood glucose levels, talk to your health care team about revising your treatment plan. Target blood glucose values may differ slightly in different care systems and with different diabetic teams. Work with your health care team on determining your specific goals before and during pregnancy. The American Diabetes Association suggests the following targets for women with preexisting diabetes who become pregnant. More or less stringent glycemic goals may be appropriate for each individual. Before a meal (preprandial) and Bedtime/Overnight: 60-99 mg/dl After a meal (postprandial): 100-129 mg/dl A1C: less than 6% Pregnancy causes a number of changes in the body, so she may need to change how she manage her diabetes. As she is having diabetes before conception, she may need to change her meal plan, physical activity routine, and medicines. As she will get closer to your delivery date, her needs might change again. i) Rest as advised. ... ii) Strictly follow the advice of Dermatologist, Physician/Diabetologist/Endocrinologist and Gynaecologist. iii ) Good glycemic control as per diet advised by Physician/Diabetologist/Endocrinologist and or Gynaecologist / Help of Registered Diatecian advised by Physician and or Gynaecologist. iii ) To consult ophthalmologists and optometrists for vision problems, nephrologists for kidney disease, and cardiologists for heart disease. If she already experiencing problems from diabetes, she will need those conditions monitored throughout her pregnancy. Precautions on the part of treating doctors and how to manage this patient :- 1 ) Formation of a team as mentioned above and one Dermatologist also to take care of skin lesions. Routine tests of pregnancy, TORCH, Quad screen tests to screens for are Down syndrome and trisomy 18, which are chromosomal abnormalities, as well as neural tube defects, such as spina bifida. The quad screen is done in the second trimester, usually between 15 and 20 weeks of pregnancy. Inj. TT1 and TT2 should be taken. Advice : - For dermatological point of view - Skin scrap for KOH Preparation and fungal culture may be useful. Insulin is the traditional first-choice drug for blood glucose control during pregnancy, because it is the most effective for fine-tuning blood glucose and it doesnt cross the placenta. Therefore, it is safe for the baby. Insulin can be injected with a syringe, an insulin pen, or through an insulin pump. All three methods are safe for pregnant women. If she has type 1 diabetes, pregnancy will affect your insulin treatment plan. During the months of pregnancy, her body's need for insulin will go up. This is especially true during the last three months of pregnancy. The need for more insulin is caused by hormones the placenta makes. The placenta makes hormones that help the baby grow. At the same time, these hormones block the action of the mother's insulin. As a result, her insulin needs will increase. If she has type 2 diabetes, she too need to plan ahead. If she is taking OHA to control her blood glucose, she may not be able to take them when she is pregnant. Because the safety of using diabetes pills during pregnancy has not been established, and her doctors will probably switch her to insulin right away. Also, the insulin resistance that occurs during pregnancy often decreases the effectiveness of OHA at keeping her blood glucose levels in their target range. Only a small number of studies have been published analyzing the safety and effectiveness of oral medications during pregnancy. Unlike insulin, oral medications cross the placenta to the unborn baby in varying degrees. For these reasons, the American Diabetes Association does not recommend their use in pregnancy. However, oral medications are now used more frequently than in the past by some health care providers to manage blood glucose levels that are not controlled by diet and exercise alone during pregnancy. Rx for Tinea incognito : - 1 ) ** NO SYSTEMIC ANTIFUNGALS. 2 ) Good Glycemic control by teamwork. 3 ) Topical Clotrimazole / Ketokonazole / Luliconazole. 4 ) Ketokonazole soap - To use during bath. 5 ) Improvementof personal hygiene.

Very good work out on diabetes in pregnancy Dr. puranjoy Thank you very much for your good info . I am very much satisfy and learn more things from your information.

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Well doctors, good answers. 1) diagnosis: TINEA COGNITO. 2) DD: Annular PSORIASIS Erythema multiforme Granuloma annulare Bubonic IMPETIGO NUMMULAR dermatitis Erythema Anuulare Centrifugum. 3) Precautions: Fungal infections and pregnancy is not dangerous It has no detrimental effect on unborn child. Fungi only live on dead tissue on the top layers of the skin. 4) MANAGEMENT: Topical applications of azoles are safe in pregnancy. Among topical azoles, safest is Nystatin (A cartegory) Next Terbinafine, Amorolfine, Ciclopiroxolamine.(B category) Among Oral antifungal ... Amphoreticin B is safest.(A category) Next Fluconazole in low doses( C category ) is indicated after first trimester of pregnancy. Among antihistamines Safest is pheneramine maleate and Hydroxyzine. But cetrizine, fexofenadine and Loratidine may be use with caution only after first trimester.

Excellent feed back, thanks sir.

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@Dr. P.kishore Kumar Very good case.Thank u for sharing. Tinea Corporis. Lulicanazole cream locally three times daily. Ketacanzole soap. No tablets should be given. Because Precious baby.

No need of oral medicine Tinr.a infection 0nly local application Strict d.m. controll Strict cotton clothe's to use For itching- try to bear it Will come round with local antifungal application and cotton clothes Still itching use calamine lotion with coconut oil Do take care of pregnancy first! Best luck 4 your pt.!

D/d teania and psoriatic dermatitis treat sugar control mixed cream at day and Cutisora Lotion at night will help no oral drug advised

@dr . Parshuram Agarwal Well doc. Can imagine how precious This pregnancy is.wow. this skin condition is not going to interfere with Pregnancy. It may have been a fungal infection considering diabetes , but use of different cream has made it very difficult to treat. She should apply Clobinet oint with GM. LOCAL gynaecologist and diabetician should also be involved.a proper antenatal care Like they do in U.K ( England). If she can't afford it do for free.

Psoriasis Fungal infection

Tinea incognito

Tinea.... Do flucanazole 150 mg with fexofenidine 120 mg, clotrimazole ointment wash dry water all clothes... Take care

Hello Dr. Salam, the patient is PRIMI and 3 months amenorrhea. Is it safe using oral medicines during pregnancy.?


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