From the Research
For a 29-year-old male with a fungal rash on the right thigh that is blanchable and itchy but not painful, I recommend prescribing oral itraconazole as the most effective treatment option, based on the highest quality study available 1. The patient's symptoms suggest a dermatophyte infection, which can be effectively treated with oral antifungals. According to the study published in The British journal of dermatology 1, itraconazole has been shown to be the most effective oral antifungal drug for the treatment of chronic and chronic relapsing dermatophytosis, with a cure rate of 66% at 8 weeks. Some key points to consider when prescribing itraconazole include:
- The recommended dosage is 5 mg/kg per day, taken for 8 weeks or until cure 1
- The patient should be monitored for potential side effects, such as gastrointestinal upset, headache, and taste disturbances 2
- It is essential to ensure the patient understands the importance of completing the full treatment course, even if symptoms resolve before the end of the treatment period, to prevent recurrence. Additionally, the patient should be advised to keep the affected area clean and dry, avoid tight clothing, and use separate towels to prevent spread. If the rash doesn't improve within two weeks of treatment, the patient should return for reevaluation as this could indicate misdiagnosis or need for alternative treatment. It is also worth noting that topical antifungal medications, such as clotrimazole 1% cream or terbinafine 1% cream, may be considered as alternative treatment options, especially for less extensive infections 3. However, oral itraconazole remains the most effective treatment option based on the available evidence 1.