Case of Dr P Dissanayake

22- year -old man with South Indian origin presented with worsening rash in his groins, pubic area, arms and buttocks for over 6 months duration. He has started this rash on his left groin and later has spread to pubic area, buttocks and forearms. He has been to various GPs and used different varieties of steroid based creams and also OTC antifungal creams. The rash has been itchy and now his wife also has similar rash in her groins for few weeks duration. He said steroid creams helped with itchiness and redness but rash never went away on stopping the creams.As he has not had lasting improvement with this rash he presented to me about 2 weeks ago.

It looked to me steroid modified chronic Tinea infection with some lichenification in his groin. Skin scrapings showed fungal hypae. He was treated with oral Lamisil(Terbinafine) 250 mg OD for 2 weeks and followed up yesterday.
On follow up his Tinea infection seems almost healed but now he has left with post inflamatory hyperpigmentation(PIH), especially in groin and pubic areas.