This murder mystery is not likely lurking in your refrigerator

Ask Dr. Keith Roach M.D

DEAR DR. ROACH: About two months ago I was diagnosed with Candida albicans, which appeared as a red rash under my breast. It itches and burns. I saw two doctors: One treated me with nystatin powder, and the other with a fluconazole pill weekly. Neither has done much good. It isn’t quite as red, but it still itches, burns and drains. Are there any other treatments? — B.B. ANSWER: Intertrigo is the name of the skin inflammation that occurs where skin folds over each other. The groin and underarms are common locations, but underneath the breast is very common, especially in women with larger breasts, where there is more skin to skin contact. Both bacteria and fungus can exacerbate the skin inflammation, and Candida albicans, a type of yeast, is among the most common. Nystatin and fluconazole are both active drugs against Candida. While addressing the fungus is an important part of treatment, there are other parts that your doctors may not have emphasized. The first is to keep the area as dry and as exposed to air as possible. It’s much more common to see intertrigo in the summer; the moisture from sweat exacerbates skin irritation and makes a good place for the fungus to grow and further irritate the skin. After washing the area with a mild soap and water, the skin should be dried thoroughly. A hair dryer with no heat is a good way of drying the area quickly. Using absorbent, breathable fabrics helps a lot. Powders, even nonmedicated ones like talc or cornstarch, will also help when applied daily. Since the nystatin isn’t helping, you might ask your doctor for a different one, such as ketoconazole or miconazole. These have anti-inflammatory as well as antifungal properties. Severe itching usually responds to mild steroid cream such as hydrocortisone, applied once or twice daily. Oral fluconazole is powerful medicine. If you don’t get better in 2-4 weeks with all of these treatments, it might be time to confirm the diagnosis, possibly with a culture or even biopsy. Finally, consider getting tested for undiagnosed diabetes, since diabetes predisposes to intertrigo. *** Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYour-GoodHealth@med.cornell. edu or send mail to 628 Virginia Dr., Orlando, FL 32803.