Fungal Skin Infection (Tinea): The Honest Truth About Desi Malams, Steroid Creams & Why It Keeps Coming Back
By Dr. Hetav K Pandya
I want to write this one the way I would talk to a patient sitting across the table in my clinic — because honestly, this is the single most frustrating problem I deal with every day, and almost every case is avoidable.
Ten years ago, if a patient came in with daad, khaaj, khujli — a fungal infection — it was a small round patch, a two-to-three week course of medicine, and we were done. Today, I regularly see young men and women walking in with fungal infection covering the groin, thighs, buttocks, waist, sometimes half the body — in dark patches, thickened skin, no ring shape left. Entire families infected. Patients who have already tried three or four "malams", two courses of tablets from different doctors, and still it comes back.
There is a very specific reason for this, and I want you to understand it clearly, because once you do, half the battle is already won.
First, what is a fungal infection?
Tinea — the medical name for what most of us call daad or ringworm — is caused by fungi that live off keratin, the protein in your skin, hair and nails. Depending on where it grows, we call it different things: tinea corporis on the body, tinea cruris in the groin and inner thighs, tinea pedis on the feet, tinea capitis on the scalp, onychomycosis in the nails. But it is essentially the same family of fungi behaving in the same way.
In its classical, untouched form, it looks like a red round patch with a raised, scaly edge that itches — often more at night or after sweating — and slowly spreads outwards. You can catch it from direct skin contact, shared towels, undergarments, bed sheets, gym mats, even damp shoes and floors.
Simple problem. Should be a simple cure. So why is India in the middle of a full-blown fungal epidemic?
Because of these tubes.
Walk into any medical store in India today, and without a prescription you can buy a cream — usually a fancy-looking tube that costs 40 to 80 rupees — that contains a potent steroid mixed with an antibiotic and an antifungal. Ingredients like clobetasol, betamethasone, beclomethasone. They are sold like magic cream. Your neighbour told you it worked. Your cousin swears by it. The chemist himself recommended it.
Here is what actually happens when you put that cream on a fungal patch:
The steroid in the cream shuts down your skin's local immune response within a day. The itching stops, the redness fades, and you honestly believe you are cured. Meanwhile — this is the part nobody tells you — the fungus is now growing without any resistance from your immune system. It goes deeper. It spreads wider. The ring shape disappears, so even a doctor cannot recognise it easily. This condition has a name: tinea incognito — hidden fungus.
Then, sooner or later, you stop the cream. And within days, the infection roars back — larger than before, in new areas, and now much harder to treat. So you buy the cream again. And the cycle deepens.
By the time such patients reach me, I am no longer treating a coin-sized patch. I am treating a chronic, extensive, partially resistant infection — often in every member of the family. And on top of that, the skin where the steroid was applied for months is now thin, discoloured, with stretch marks, visible blood vessels, and permanent pigment changes. That damage does not fully reverse.
If you take away one thing from this article, let it be this: please do not put any cream on your skin without knowing exactly what is in it, and please never trust a "combination" cream sold over the counter for daad.
And now, about the desi malams and the "guarantee" people
I say this with genuine respect for the patients who come to me having tried these things — you were not being foolish. You were being hopeful, and someone took advantage of that hope.
But here is the honest reality of what happens in the market. Somebody in your neighbourhood claims a black paste, a herbal oil, a jadi-buti, or a "family recipe" that cured his daad in a week. Someone in the next lane offers a "100% guaranteed cure" for a few hundred rupees. Bottles of oil in the market carry photographs of before-and-after miracles.
When these products are actually sent to a laboratory — and this has been done, many times, in India — a very large percentage are found to contain hidden clobetasol or betamethasone, the same potent steroids I talked about above. You cannot see it, cannot taste it, cannot smell it. All you feel is the instant relief steroids give, and you assume the "herbal remedy" is working.
It is not working. It is switching off your skin's defence and letting the fungus quietly settle in for the long term. And the long-term price of applying steroids on the skin — apart from the fungus getting worse — includes thinned skin, permanent stretch marks, dark patches, acne-like eruptions and, in large-area users, actual hormonal side effects.
Please remember: no honest doctor will ever guarantee a cure for daad. We will give you our best plan and honestly warn you it needs weeks of discipline. Anyone offering a "100% guaranteed" cure is either lying, or is quietly adding a steroid to whatever they are selling.
The tablet story — why Itraconazole must be finished
For moderate to severe fungal infection today, we usually rely on an oral antifungal — most often Itraconazole, sometimes Terbinafine, sometimes others depending on the case. And here is where the second half of the problem happens.
Itraconazole is not a three-day antibiotic. A typical course today is four to eight weeks, sometimes longer if the disease is extensive. What almost always happens is that after two weeks, you feel around 80% better. The itching is gone. The redness has faded. The skin looks nearly normal. And this is exactly the point at which most patients — quietly, without asking — stop the medicine.
But the fungus is still alive. It is sitting in the deeper layers of the skin, inside hair follicles, and in your clothes, towels and bed sheets. When you stop early, the fungi that survive are the toughest ones — and they multiply. The next time the same infection flares up, the same tablet does not work as well. Your dermatologist has to give a higher dose, for longer, or switch to a different drug. Sometimes we end up using combinations that need liver monitoring and months of treatment. And every incomplete course by every patient makes this worse for the next patient in line.
This is not a small problem. India is currently dealing with a resistant strain called Trichophyton indotineae, and incomplete tablet courses — combined with the steroid cream story above — are exactly why.
Please finish the full duration your dermatologist prescribes, even if your skin looks perfectly normal after two weeks. Do not save tablets for the next episode. Do not share them with family members. Come back for a review instead — that is what the review appointment is for.
What actually works
Real treatment of fungal infection has three parts, and honestly, the medicine is only one of them.
One — the right medicine, prescribed properly. Oral antifungal (usually Itraconazole or Terbinafine) for the full duration your dermatologist decides. A plain antifungal cream — luliconazole, terbinafine, sertaconazole, ketoconazole — without any steroid — applied twice a day, and importantly, applied about two centimetres beyond the visible edge of the patch, because the fungus is always a bit ahead of what your eye can see. Sometimes an antihistamine at night to control itching so you don't scratch and spread it further. In certain patients, a blood test before or during oral therapy.
Two — clothing and environment. This genuinely does half the work. Wear loose cotton clothes. Avoid tight jeans, synthetic underwear and gym leggings while you are being treated. Change underwear and inner clothes twice a day during active infection. After a bath, dry the skin properly — especially the groin, under the breasts, between the toes, the armpits. Fungus loves damp skin. Iron your undergarments and inner clothing — the heat kills fungal spores that survive normal washing. Wash clothes in hot water if you can; sun-dry them. Do not share towels, soaps, combs or razors. And critically — everyone in the family with symptoms must be treated together. If your wife is on treatment and you are silently itching but hoping it will settle, you will keep re-infecting each other for months. This is one of the most common reasons for recurrence I see.
Three — the background stuff we often ignore. Overweight patients with deep skin folds get repeated infections in the groin and under the breasts; even five to seven kilos of weight loss makes a visible difference to recurrence. Uncontrolled blood sugar is a major reason fungal infections keep coming back — if your daad keeps recurring, please get an HbA1c done. Long-term steroid use for any reason — oral, inhaled, topical — lowers your skin immunity, so we sometimes need to plan around that. If you are a gym person, use your own towel, don't sit in wet clothes on shared benches, shower and change immediately after your workout. If your feet sweat, rotate shoes, let them dry fully, and use an antifungal foot powder.
Things that don't help — and honestly, often make it worse
Over-the-counter steroid-antibiotic-antifungal combination creams. Desi malams, herbal pastes, oils, cow-based products and kadhas applied on the patches. Bleach, kerosene, lime, garlic or thick turmeric paste rubbed on the skin — these cause chemical burns and permanent pigmentation without touching the fungus. Antifungal soap alone — it can help as an add-on, but it will never cure an infection on its own. Stopping the medicine the moment itching goes away. And treating only one person in the family while the rest silently keep re-infecting.
When to come and see me
Do not experiment for months at home. Please come in if you have a red, itchy, ring-shaped patch anywhere on the body; if the itching in the groin, thighs, under the breasts or between the toes is not settling in about a week; if your nails are becoming thick, yellow or crumbling; if the same fungal infection keeps coming back after treatment; if you have already used a "malam" from the store or from a quack and things are now worse or looking different; or if someone else in the family has the same patches.
The earlier you come in — before the steroid creams have been used — the shorter, cheaper and easier the whole treatment is.
One honest last word
Fungal infection is treatable. Even chronic, incognito, resistant fungal infection is treatable — but it takes patience, honest medicine, and discipline at home. There are no shortcuts, no magic malams, and no guaranteed cures. Anyone who tells you otherwise is either lying or slowly damaging your skin.
If you have been struggling with recurrent daad, please throw the tube in your drawer today, and come in for a proper evaluation. We will go through the full plan together — medicines, clothing, family screening, lifestyle — and get your skin back to normal the right way.
This is a patient education article. It is not a substitute for a personal consultation. Every case is different, and the exact medicine, dose and duration must be decided by your dermatologist after examining you.