From the Guidelines
The likely diagnosis for a fungal rash in the right axilla of an African-American male is tinea corporis (ringworm) or tinea versicolor, with candidiasis also being a possibility, and treatment should begin with topical antifungal medications such as clotrimazole 1% cream or miconazole 2% cream applied twice daily for 2-4 weeks. When considering the diagnosis of a fungal rash, it's essential to note that microscopy and clinical suspicion have been used for decades, but culture remains the gold standard for diagnosis of fungal infections, as seen in the diagnosis of vulvovaginal candidiasis 1. However, in the context of a fungal rash in the axilla, the diagnosis is often based on clinical appearance, with fungal infections typically presenting as red, scaly patches that may be itchy and have raised borders. Some key points to consider in the treatment of fungal rashes include:
- Keeping the affected area clean and dry, as fungi thrive in warm, moist environments
- Wearing loose-fitting, breathable clothing to help prevent recurrence
- Continuing treatment for the full prescribed duration, even if symptoms improve earlier, to prevent recurrence
- Being aware of the potential for post-inflammatory hyperpigmentation in African-American skin, which can persist after the infection clears and may be addressed with gentle exfoliation and time. It's also important to note that oral antifungal therapy may be necessary for more severe cases, such as fluconazole 150mg once weekly for 2-4 weeks or terbinafine 250mg daily for 2 weeks, as referenced in the treatment guidelines for vulvovaginal candidiasis 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Fungal Rash Description
- A fungal rash in the right axilla of an African-American male can be described as a well-demarcated, sharply circumscribed, oval or circular, mildly erythematous, scaly patch or plaque with a raised leading edge 2.
- Mild pruritus is common, and the diagnosis is often clinical but can be difficult with prior use of medications, such as calcineurin inhibitors or corticosteroids.
Likely Diagnosis
- The likely diagnosis for a fungal rash in the right axilla is tinea corporis, a common fungal infection that mimics many other annular lesions 2.
- Dermoscopy is a useful and non-invasive diagnostic tool, and if necessary, the diagnosis can be confirmed by microscopic examination of potassium hydroxide wet-mount preparations of skin scrapings from the active border of the lesion 2.
- Fungal culture is the gold standard to diagnose dermatophytosis, especially if the diagnosis is in doubt and results of other tests are inconclusive or the infection is widespread, severe, or resistant to treatment 2.
Treatment Options
- The standard treatment of tinea corporis is with topical antifungals, such as terbinafine 1% cream, which has been shown to be effective in treating tinea pedis and tinea corporis/cruris 3, 4.
- Systemic antifungal treatment, such as oral terbinafine, may be indicated if the lesion is multiple, extensive, deep, recurrent, chronic, or unresponsive to topical antifungal treatment, or if the patient is immunodeficient 2.
- However, the effectiveness of oral antifungal drugs, including terbinafine, has been limited in some studies, and itraconazole has been shown to be the most effective drug in chronic and chronic relapsing dermatophytosis 5.