Resolving tinea into 4th week of treatment - Part 2

Check attached case at bottom So my patient who is into fourth week of oral antifungals and locally he is applying lulimac 1% lotion once daily, as the area is quite wide Infection is resolving, and patient is relieved And after completion of fourth week,I would like to stop Lulimac 1% lotion and put him on some bleaching agent Management So the next big concern is that - How to tackle darkened skin/hyperpigmented areas of skin in cases of resolving tinea infection?

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Postinflammatory pigmentation is temporary pigmentation that follows injury or inflammatory disorder of the skin. It is mostly observed in darker skin types. Postinflammatory pigmentation is also called acquired melanosis. Inflammation in the epidermis stimulates melanocytes to increase melanin synthesis and to transfer the pigment to surrounding keratinocytes . If the basal layer is injured (e.g. lichen planus), melanin pigment is released and subsequently trapped by macrophages in the papillary dermis Treatment broad-spectrum sunscreen is important to minimise darkening caused by UVR in exposed areas of body Kojic acid based cream Tretinoin cream Vitamin C cream

Nice pathophysiologicl description Dr jayesh
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Post Inflammatory Hyperpigmentation except vitamin C nothing is needed. Vitamin C works as Reducing Agent and hence reduces epidermal melanin. Dermal melanin takes 4 to 6 months for clearing. It is natural process. No need to treat by any Cream.

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Right now primary aim is to eradicate Tinea, and to prevent recurrence. Recurrence can be prevented by weekly Fluconazole 150 mg for 3- 4 months Post Tinea,pigmentation- can be taken care of later on - because any topocal cream used for pigmentation like kojivit ultra , glossage,will keep the area moist and wet and recurrence of Tinea can occur So- right now,aim - should be to prevent recurrence

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PIH * Steroid orally and. *Hydroquinone.. * Peeling Tretinoin cream. PABA cream locally during exposure to sunlight and bad weather conditions. Alovera gel.

Thanks Dr SI Godara
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A c/o tenia corporis incognito under treatment responded well In my opinion continue local application for another 2 weeks before withdrawal as recurrence are there So far hyperpigmentation is concerned it could PIH or lulicanazole known to give blackening which gets resolved naturally after withdrawal Yes moisturisers are advised If darkening is a big issue you can advise cosglow at night

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? PIH .. MANAGEMENT.. * HYDROQUINONE.. * GLYCOLIC ACID .. AA PEELING.. * CYSTEAMINE CREAM.. * VITAMIN C CREAM .. * TRETINOIN CREAM .. * CORTICOSTEROIDS CREAM .. * ALOE VERA GEL ..

It effects of melecyt overactive It reduces spontaneous Lt Cont TT nex 1month Use retinoids ont at night Glycolic acid Or PABA are some ont presbred by dematologust however it's disappearance is seen without any special application

Continue local antifungal for 2 more weeks. Then use antifungal powder for few months. Keeping parts dry, removing undergarment at night will minimize reinfection.

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Post inflammatory hyperpigmentation .. Need vitamin C , Vitamin C . And alovera .. Nothing more is required

Infective pigments need no treatment till 1 month. Then we can start depigmentation creams. Till that time can apply Zinc-calamine lotions...

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