Practice Points
1. If an eczema-like rash does not respond to topical steroids, consider the possibilty of tinea. Similarly, if a tinea-like rash fails to respond to topical antifungals, consider the possibilty of eczema.
2. If the response to a mild topical steroid is unsatisfactory, resist the temptation to just prescribe a more potent one, particularly for facial rashes. Fungal studies or a biopsy might be more appropriate.
3. Contact dermatitis due to nail varnish produces rashes over the face or thoat rather than on the fingers.
4. Contact reactions to topical steroids, to their vehicles, and/or to other contained chemicals are possible, and neomycin, which has no activity against dermatophytes, is a potent sensitizer.