Skin infections are the most over-treated and under-diagnosed problems in dermatology. Almost everyone who comes in with a persistent itchy rash has already been through two or three creams from the chemist – usually a combination cream containing a strong steroid, an antifungal and an antibiotic all in one tube. That combination briefly calms the itch while allowing a fungal infection to spread quietly underneath, producing the confusing, wide, poorly-defined rash dermatologists call tinea incognito.

The fix is not a stronger cream. It is a diagnosis – and often that means a two-minute skin scraping.

Fungal infections we treat

  • Tinea corporis (ringworm) – ring-shaped patches with a raised, scaly, advancing edge and clearing centre.
  • Tinea cruris (jock itch) – itchy, spreading rash in the groin and inner thighs, aggravated by heat and sweat.
  • Tinea pedis (athlete’s foot) – itching, scaling and splitting between the toes; a common gateway for cellulitis.
  • Tinea capitis – scalp ringworm, mainly in children, causing scaly patches with broken hairs and hair loss. This needs oral treatment – creams do not reach the follicle.
  • Onychomycosis – thickened, crumbling, discoloured nails. Slow to treat and worth confirming before committing to months of therapy.
  • Pityriasis versicolor – pale or fawn patches on the chest, back and shoulders, very common in Nairobi’s humid months; the pale patches take months to re-pigment even after successful treatment.
  • Candida – in skin folds, under the breasts, in the groin and around the nails, often with an underlying cause such as diabetes.

Bacterial and other infections

  • Impetigo – golden-crusted, highly contagious sores, common in children.
  • Folliculitis – infected hair follicles; on the beard area and legs it is often made worse by shaving.
  • Boils and carbuncles – deeper abscesses that may need drainage. Recurrent boils prompt a search for carriage or an underlying cause.
  • Cellulitis and erysipelas – spreading redness, warmth, swelling and fever; urgent, and often triggered by untreated athlete’s foot.
  • Hidradenitis suppurativa – recurrent painful nodules and tunnels in the armpits and groin. Not simply “boils”, and needs long-term dermatological management.
  • Scabies – relentless night-time itching with burrows in the finger webs and wrists. Treatment must include the whole household, or it comes straight back.
  • Viral infections – herpes simplex, shingles, molluscum and warts.

How we diagnose infections properly

  1. Examination of the full affected area – including feet, groin and nails, since one untreated site keeps reinfecting the others.
  2. Skin scraping for microscopy and fungal culture – quick, painless, and it settles the fungus-or-eczema question that so many creams have been wasted on.
  3. Bacterial swab where there is pus or crusting, with sensitivities to guide antibiotic choice.
  4. Nail clippings before starting months of oral antifungal therapy, because up to half of “fungal” nails are not fungal at all.
  5. Blood tests where recurrent or unusually widespread infection suggests diabetes or another underlying condition.
  6. Skin biopsy when the rash does not fit any of the usual patterns.

Treatment

Once the organism is known, treatment is straightforward and effective:

  • Topical antifungals for limited skin infection – used for the full course, and for two weeks after the rash disappears.
  • Oral antifungals for scalp, nail, widespread or resistant infection. Nail treatment runs for three to six months; the nail then takes six to twelve months to grow out clear.
  • Antibiotics – topical or oral, guided by swab results where possible.
  • Drainage of abscesses where required.
  • Scabies treatment for the patient and every household contact simultaneously, with instructions on bedding and clothing.
  • Stopping the combination creams that have been muddying the picture.

Stopping reinfection

  • Treat the feet and the groin at the same time – one reinfects the other constantly.
  • Do not share towels, razors, combs, clippers or shoes. Ask your barber about clipper hygiene.
  • Wash and hot-iron towels and bedding during treatment.
  • Dry thoroughly between the toes and in skin folds; change out of damp sports kit promptly.
  • Treat pets with suspected ringworm – cats and dogs are a common source in children.
  • Finish the full course. Stopping when it looks better is why it comes back.

Why combination creams cause so much trouble

The widely sold creams that mix a potent steroid with an antifungal and an antibiotic are a genuine public health problem. The steroid suppresses the inflammation, so the itch improves and the patient assumes it is working. Meanwhile the fungus spreads, the rash loses its typical ring shape, the skin thins, and by the time it reaches a dermatologist it is extensive, atypical and much harder to treat – and often needs oral therapy that a simple cream would have avoided.

If you have been using one of these, bring the tube with you. It usually explains what we are looking at.

Telling the four look-alikes apart

Most persistent rashes seen in Nairobi are one of four things, and they look increasingly similar the longer they have been treated with the wrong product. This is the single most useful table on the site.

Condition Typical clue What settles it
Fungal (ringworm, tinea) Spreading ring with a raised, scaly, active edge and clearer centre Skin scraping under the microscope
Eczema Poorly defined, intensely itchy, often symmetrical, personal or family history Examination plus history; scraping negative
Psoriasis Well-defined thickened plaques, elbows, knees, scalp; nail pitting Examination, sometimes a biopsy
Steroid-modified rash Once-typical rash now blurred, wider, oddly flat, worse each time cream stops History of combination cream use plus scraping

Bacterial infections we treat

  • Impetigo – golden-crusted sores, common in children, spreads easily through a household.
  • Folliculitis – inflamed spots centred on hair follicles, often after shaving or in occlusive clothing.
  • Boils and abscesses – painful, deep and requiring drainage rather than creams.
  • Cellulitis – spreading warmth, redness and tenderness with feeling unwell. This one is urgent; do not wait.

Stopping reinfection at home

  1. Treat feet and groin together. Tinea travels between them, and clearing one guarantees the other returns it.
  2. Dry the feet last, or with a separate towel, so you are not carrying it up the body.
  3. Alternate footwear. Closed shoes worn daily never dry out.
  4. Wash bedding and towels hot, and do not share them, including with family who have no symptoms yet.
  5. Finish the full course. Antifungal treatment is abandoned early more than any other, because the itch settles long before the infection has gone.
  6. Check the pets if a child keeps getting ringworm – cats and dogs are a common reservoir.

Skin infections in Nairobi – questions patients ask

How do I know if my rash is fungal or eczema?

Often you cannot tell by looking, especially once creams have been applied. A skin scraping examined under the microscope gives a quick answer and prevents months of the wrong treatment. See also eczema treatment.

How long does fungal nail treatment take?

Oral treatment usually runs three to six months, and the nail then grows out clear over a further six to twelve months for toenails. Clippings are sent for confirmation first because a good proportion of abnormal nails are not fungal.

Is ringworm contagious?

Yes – by direct contact and through shared towels, bedding, combs, clippers and pets. Household members with the same rash should be treated at the same time.

Why do my boils keep coming back?

Recurrent boils may reflect staphylococcal carriage, diabetes, iron deficiency or hidradenitis suppurativa. Repeated antibiotic courses without investigating the cause rarely stop the cycle.

My child has ringworm on the scalp – is a cream enough?

No. Scalp ringworm needs oral antifungal treatment because creams cannot reach the hair follicle, and untreated it can cause permanent hair loss. See paediatric dermatology and hair loss treatment.

How is scabies treated?

With a prescribed topical or oral treatment applied correctly, and every household member treated on the same day whether or not they itch. Bedding and clothing are washed hot. Itching can persist for two to four weeks after successful treatment – that is not treatment failure.

Why so many skin infections are treated three times before they clear

Fungal and bacterial skin infections are among the easiest conditions in dermatology to treat correctly and among the most commonly treated incorrectly. The gap between those two things is almost always a missing diagnosis.

The usual sequence is familiar. A rash appears, a cream is recommended over the counter, the itch settles within days, and it looks solved. Weeks later it is back and slightly larger. A second cream does the same. By the third the rash has spread, the border has blurred, and it no longer looks like the thing it started as.

What is going on

A great many combination creams sold without prescription contain a potent steroid alongside an antifungal and sometimes an antibiotic. The steroid is the component that works quickly: it suppresses inflammation, which is what the itch and redness are made of. It also suppresses the local immune response, which is precisely what a fungal infection needs in order to spread further.

The result is a condition dermatologists see constantly – a fungal infection that has been partially treated, partially suppressed and substantially disguised. It is still entirely treatable. It simply takes longer than it would have at the start, and it needs to be identified for what it is first.

How it gets settled properly

  • A skin scraping. Two minutes, taken in the clinic, and it distinguishes fungal infection from eczema and from a steroid-modified rash – three things that look similar at this stage and need completely different treatment.
  • Treating the right organism, for the right length of time. Fungal treatment is stopped early more often than any other, because the itch settles well before the infection has actually cleared.
  • Dealing with the reservoir. Feet and groin reinfect each other, household members reinfect one another, and footwear and towels carry it. Treating the person while ignoring the source guarantees recurrence.
  • Managing the steroid withdrawal where one has been used for months, since stopping abruptly causes a rebound flare of its own.

If you are already using something, bring the actual tube to your appointment rather than the name. Two creams in near-identical packaging can contain very different steroids, and knowing which one you have been applying, and for how long, changes what happens next.

Can I catch this from someone at home?

Several of these spread easily – ringworm, impetigo and scabies in particular. That is why we ask about everyone in the household, and why treating one person while others go untreated leads to the infection bouncing back.

Why does it keep coming back after treatment?

Usually one of three reasons: the course was stopped early, the reservoir was never dealt with (footwear, towels, an untreated family member or pet), or it was not actually the infection we thought it was. All three are fixable once identified.

Is it safe to use a cream I have left over from last time?

It is a gamble. If the last diagnosis was wrong, you are repeating the wrong treatment, and if the cream contains a steroid you may be actively feeding a fungal infection. Bring it in rather than guessing.

Book skin infection treatment in Nairobi

If a rash has not cleared after two weeks of treatment, do not buy a third cream – come and get it diagnosed. A scraping takes two minutes and often changes the treatment completely.

SkinByDrNancy is at Landmark Plaza, 2nd Floor, Argwings Kodhek Rd, Nairobi. Call or WhatsApp 0728 566990, email info@skinbydrnancy.com, or use the online booking form. We are open Monday to Friday 7:00am – 6:30pm and Saturday 7:00am – 12:00pm, and most medical insurance schemes are accepted.

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Book skin infection treatment with Dr Nancy Omwenga

Landmark Plaza, 2nd Floor, Argwings Kodhek Rd, Nairobi. Same-day appointments and walk-ins are available where the diary allows, and most medical insurance schemes are accepted.

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Book with Dr Nancy Omwenga

Same-day appointments and walk-ins are available. Most medical insurance schemes are accepted.

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Clinic details

SkinByDrNancy
Landmark Plaza, 2nd Floor, Argwings Kodhek Rd, Nairobi
0728 566990
info@skinbydrnancy.com

Mon – Fri 7:00am – 6:30pm
Sat 7:00am – 12:00pm
Sunday closed

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