From the Research
Topical steroid use can worsen a fungal infection by suppressing the local immune response and creating an environment where fungi can thrive and spread more easily. This phenomenon, known as tinea incognito, occurs when conditions like ringworm or athlete's foot become more extensive and atypical-looking after steroid application 1. Common topical steroids that may cause this include hydrocortisone, triamcinolone, betamethasone, and clobetasol. If you suspect a fungal infection, it's best to avoid steroids completely until the infection is properly diagnosed and treated with antifungal medications like clotrimazole, miconazole, or terbinafine.
Some key points to consider:
- The use of topical corticosteroids can increase susceptibility to bacterial and fungal infections, and therefore may preclude them from use when infection is the known cause of the disease 2.
- The potent anti-inflammatory actions of these drugs can hamper the skin's ability to fight fungal organisms, allowing them to multiply rapidly and potentially spread to larger areas of skin.
- Antifungal-steroid combination products might seem like a solution, but these should only be used under medical supervision for specific conditions and limited durations 3, 4.
- Discontinuing topical steroids can induce worsening of clinical signs in fungal keratitis, and it is recommended to slowly taper steroids and continue or commence appropriate antifungal therapy 1.
In terms of treatment, it is essential to use antifungal medications that are effective against the specific type of fungal infection, such as azole drugs like miconazole, clotrimazole, and ketoconazole, or allylamines like terbinafine 5. The choice of treatment should be based on the type, location, and surface area of the infection, as well as patient age, degree of inflammation, and underlying comorbidities 3.