Hello
Thanks for posting your query at DoctorSpring.com
I can understand your concern.
It seems to be a bacterial infection of the skin. Triamcinolone is a steroid cream which takes care of the inflammation but doesn't treat the infection itself instead it lets the bacteria flourish. Hence you find that the spot goes away temporarily but comes back.
I would recommend that you apply mupirocin cream over it twice daily for a week. You will require a prescription for the cream.
That will help in treating the infection.
Please let me know if you have any queries.
Take care
Patient replied :
I went to my General Dr. and he put me on Levofloxacin 500mg 10 tablets. 1 p/day. I took them all as prescribed and shortly after finishing, the red spot(s) returned.
He then called in Clotrimazole 1% 15gm. I have been taking that for the past few days and a small red spot appeared and has gotten bigger while using the new cream. I am wondering if that is normal and I noticed that the cream he prescribed was fungal not bacterial, so I am not sure whatI should do now since this "what ever I have" doesn't seem to want to go away. I wanted to ask your advise if I should see a specialist or "demand" the cream (from my Dr.)that you recommended me in the first place.
Hello
Thanks for your reply.
Clotrimazole cream being an anti fungal cream will not be as effective for the bacterial infection that you seem to be having.
I would recommend that you request your doctor for the prescription of mupirocin cream and apply it twice a day for two weeks.
Take care
Patient replied :
After our conversation I called the doctor and he placed me on the mupirocin cream 2%. I started using it Tuesday night and I'm going into the 5th day using it. I sent you an updated picture. The current picture is the way it has been since before starting the mupirocin cream. It doesn't seem to get worse and it doesn't seem to be getting any better. I don't know if I'm being to impatient since I've had this infection for almost a year and maybe it needs longer but it says there should be results between 3-5 days and I'm not seeing any change. Since I've taken antibiotics now for it and used fungal cream and the bacterial cream and nothing seems to get rid of it but the Triamcinilone cream (which I know that cream isn't doing me any good) but it comes back in same exact spot every time and doesn't seem to spread, I'm becoming more and more concerned that I do have a STD or something incurable. I know I'm going to have to go see my Doctor this week but since you are a specialist, I wanted to update you and ask your thoughts.
Hello
Thanks for your reply.
From the picture, there seem to be a few possibilities,
1. Granuloma annulare which is a condition where there are annular lesions with central sparing, it's an inflammatory condition where there is a collection of inflammatory cells in the skin.
2. Herpes, since its recurrent, there seem to be fluid filled lesions in clusters. But since you have already done all tests for std and its negative, that needs to be investigated further.
I would recommend that since the creams are not effective enough, the diagnosis needs to be confirmed by doing a biopsy. The treatment can then be decided according to the reports.
Please let me know if you have any queries.
Take care
Patient replied :
Since after your reply, I will probably close this conversation,I wanted to say thank you for all the help you have given me. It has been greatly appreciated and has made this experience a whole lot easier to deal with. Thank you so very much!
Now for the update and a few questions. I have enclosed a picture at day 10 of using the mupirocin cream (about day 13 of having it start to show up again). It looks a whole lot better but it is still not completely gone. I went to the Dr. at day 8 and he said that he wanted me to continue using the cream and we pretty much ruled out Herpes as I have never had any signs/symptoms for it. The picture was misleading as they were just raised bumps and not liquid filled. I have never had a sore, blister, pain or any type of fluid come from this. I am not totally convinced this was a bacteria infection since it is not completely gone yet but not sure if that is because I have had this for almost a year before getting it treated and wouldn't a bacteria infection have spread as opposed to staying in the same place?
I am leaning more towards your conclusion of an inflammatory condition since every time for the past year that the redness would show up, the Triamcinolone would take it away within 24-48 hours.
Currently it is really dry and flaking skin over the area. One thing I never explained to you when it started to show up this last time and not sure it matters but one very small red mark showed up towards the top part of the head (I was using the fungal cream at this time) the redness then got a little bigger and traveled from that spot down towards the base of the head and became what I sent you in the second picture (picture was day 4 of using the mupirocin cream) but still in the same area(s) I have always had the redness appear for the past year.
If it is Granuloma annulare (which after looking at pictures of it online it does sorta look like that) I am guessing there isn't much that can be done but to use the Triamcinolone cream and hope it resolves itself?
I have found that your profession is in high demand. I could fly to India probably get an appointment to see you and be back here before I could get in to see a Dermatologist here.
Since it appears to be going away, do I need to wait to see if it comes back before trying to get the biopsy or can they still do it even with it starting to fade? Also, what would a Dermatologist do, being where the "rash" is, to take the sample and do the biopsy on it?
Sorry for this being so long and thank you again for all your assistance.
Hello,
It does seem to be granuloma annulare which is an inflammatory condition. It doesn't seem to be bacterial infection. Bacterial infection of skin would spread only in that local area.
The treatment for granuloma annulare is application of triamcinolone cream.
The biopsy can still be taken even if the lesion is fading off, the biopsy will help in coming to a conclusive diagnosis about what it actually is.
Take care