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Pharmacy/topical steroids & anti fungal creams

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Question
i was prescribed different strength topical steroids over time for an itch and rash i cant seem to fully get rid of. is there any concern as to applying theses different steroid creams one after the other, some are very potent, some are potent and some are less potent. also when prescribing the different topical steroids i am also given a prescription for a different anti fungal cream to apply along with the steroid cream, that i am told to apply.

Answer
Hi Anthony,
So, just to reiterate, you have two steroid creams which have been prescribed over the years for a recurring rash.  The steroid creams contain the same active ingredients but differ in their potency.  Have I got this right?  Firstly, I would ask you to check their expiry dates.  The next step is to ask your physician which strength he/she prefers.  If you are unable to do this, my advice would be to use the lowest strength until you are able to receive clarification.  Applying more than one steroid is not recommended and does not offer any synergistic benefit.

It is possible that your rash is not clearing because there has been an underlying fungal infection.  This is quite common, in fact.  Overuse of steroid creams change the appearance of a rash and can mask the signs of an infection.  This gives you the impression that the condition has resolved, but in reality the problem is still festering.  It is perfectly normal to be using an anti-fungal cream alongside your steroid treatment.  I would recommend spreading and interposing the doses throughout the day.  For example, if you are using each cream twice a day, apply one in the morning, the other at midday, then repeat again at 5pm and before bed.     

Usually, we recommend continuing with this steroid/anti-fungal combination until the rash or redness disappears.  Then, stop the steroid cream but continue with the anti-fungal cream for another week or two.  This will ensure that the fungal infection is completely eliminated.  Do not stop using the anti-fungal cream prematurely.  Even if symptoms have subsided, complete the full course of treatment.  If the infection is not fully cleared, there is a good chance that it will return.

Lastly, fungal infections are known to spread, so when washing, try to use fresh towels if you can and do not share your towels with family or housemates.  I am not sure where you rash is, but try to wash regularly and thoroughly dry the area.  If you can, try to keep the skin dry and exposed to air.  Avoid clothing that is restrictive, avoid synthetic fabrics which do not breathe but trap moisture and heat.  Fungus thrives in such environments.

I hope this helps, Anthony.  Take care.  

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Gisella Campanelli

Expertise

I am able to answer questions relating to pharmaceuticals, therapeutic regimes and primary health care. This includes offering advice on drug indications, dosages, and disease state management. I can also identify side effects, drug interactions and contra-indications, and offer recommendations on ways to mitigate these. I can diagnose minor illnesses and suggest appropriate over-the-counter remedies and/or preventive healthcare tips. I can recognize cardinal symptoms which would otherwise require referral to a medical practitioner.

Experience

I am a registered pharmacist in Australia, and I have practiced in a hospital pharmacy for over thirteen years. My clinical specializations lie within the areas of psychiatry and general medicine (including gastroenterology, respiratory, endocrinology, neurology, infectious diseases, gerontology, dermatology). I self-managed the training program for pharmacy interns in preparation for their final registration exams, and I have worked for the Pharmacy Board of Australia as an examiner and exam writer.

Education/Credentials
I hold a Bachelor of Pharmacy from the Victorian College of Pharmacy, Monash University, and I am board-registered to practice within Australia. I also hold a Master's degree in an unrelated field (art conservation).

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