Is It Normal to Experience Peeling After Fungal Treatment?

Is it normal to still experience peeling after applying medication for a fungal infection?

Hello Doctor,
1.
About 10 days ago, I developed two to three rings of red papules on my foot that are itchy and peeling.
The initial diagnosis was tinea, and after using an antifungal spray for 10 consecutive days, the red papules have gradually faded and disappeared.
However, the area where the ring-shaped red papules were still shows signs of peeling, which I refer to as "ring-shaped peeling" (the redness in the peeling area is not very prominent but still slightly red).
Is this normal? (I am a bit worried and scared.)
2.
I would like to ask if using the antifungal spray after showering and before bed each day could lead to an overdose issue? My mother has been arguing with me, believing that spraying twice a day is harmful to my health, which has caused family discord.
3.
I am a carrier of hepatitis B, and it seems that I should avoid oral antifungal medications that may negatively affect the liver.
If I continue using the antifungal spray for 6 weeks without improvement, and if my primary physician decides to change the treatment to prescribe oral antifungal medication, can I request the doctor to prescribe Fluconazole, which has a lesser impact on the liver? Additionally, in the case where "topical treatment is not effective," will the prescription of oral Fluconazole be covered by health insurance?

Lin Xiaohua, 30~39 year old female. Ask Date: 2018/05/07

Dr. Wu Yuxin reply Dermatology

1.
You should consult your attending physician about this issue, as they are the most familiar with your condition.
2.
No.
3.
It will be out-of-pocket expenses.

Reply Date: 2018/05/07

More Info

When treating a fungal infection, it is not uncommon to experience some skin reactions, including peeling, redness, and dryness, especially after using topical antifungal medications. In your case, the appearance of peeling skin after using the antifungal spray (療黴舒) for about ten days is a response that can occur as the skin heals. The initial inflammation and infection can lead to skin irritation, and as the infection resolves, the skin may shed its outer layer, resulting in peeling. This phenomenon is generally normal and can be part of the healing process. However, if the peeling is accompanied by significant discomfort, increased redness, or signs of secondary infection (such as pus or increased swelling), it would be advisable to consult a healthcare professional.

Regarding the frequency of application, using the antifungal spray twice a day (after showering and before bed) is typically within the recommended usage for many topical antifungal treatments. However, it is essential to follow the specific instructions provided by your healthcare provider or the product's label. If your mother is concerned about the frequency, it may be helpful to discuss this with your doctor to clarify the appropriate dosage and alleviate any worries about potential side effects. In general, using the spray as directed should not pose a risk of overdose, but excessive use beyond the recommended guidelines could lead to skin irritation or other side effects.

As for your concern about being a carrier of hepatitis B and the implications for antifungal treatment, it is crucial to communicate this information to your healthcare provider. Certain oral antifungal medications can have hepatotoxic effects, and your doctor should consider your liver health when prescribing treatment. If topical treatments are ineffective after a reasonable duration (like six weeks), your doctor may consider switching to an oral antifungal. You can certainly discuss the possibility of using Fluconazole, which is generally considered to have a better safety profile regarding liver toxicity compared to some other antifungals.
Regarding insurance coverage for Fluconazole, this can vary based on your specific health insurance plan and the regulations in your region. Typically, if a healthcare provider deems it medically necessary, there is a good chance that the treatment may be covered. It is best to check with your insurance provider or your healthcare provider's office for specific details regarding coverage.

In summary, while peeling after antifungal treatment can be normal, it is essential to monitor your symptoms closely. If you have concerns about the treatment regimen or the potential need for oral medication, do not hesitate to reach out to your healthcare provider for guidance. They can provide personalized advice based on your medical history and current condition, ensuring that you receive the most appropriate and effective treatment.

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