Q: My 14 years old daughter has been suffering from fungal infection for the last six months and has developed several white spots on cheeks, face, back, arms and legs with light itching. We tried treating her with homeopathy but her condition worsened. Now, we have been using Flucanozole (150 mg) twice a week and applying Candid B at night for the last three months. At times, it looks as if her condition is improving but patches are reappear and sometimes, she experiences severe itching. The white patches are in round shape and no new patches have formed after taking Zocon. When will her condition improve? Will Tacroze Forte help? My son aged 6 years also got infected but was cured immediately by medication. Please help.

A:Your child appears to have a condition called pityriasis versicolor. Pityriasis versicolor is a rash caused by a yeast-like germ called pityrosporum. Small numbers of this germ commonly live on the skin, and do no harm. However, some people seem prone to this germ multiplying on their skin more than usual, which leads to a rash. Often the germ multiplies and causes the rash for no apparent reason. In some cases, hot, sunny, or humid weather seems to trigger the germ to multiply on the skin. The rash usually starts as small pale patches. At first these usually appear on the chest, neck, or upper arms. The rash sometimes spreads to the abdomen, thighs, and back. More patches may appear, and patches next to each other may join together. The affected skin may become slightly scaly. The rash is usually pale, and is barely noticeable if you are fair-skinned. You may not notice it until after you sunbathe. Affected areas do not tan, and therefore the rash becomes more obvious on tanned skin. The pale patches are more obvious if you have dark skin. (Sometimes the rash is darker than the skin in fair-skinned people, and it looks like brown marks.) There are usually no other symptoms. Sometimes it is slightly itchy. But it is a nuisance as pale patches on tanned skin may look unsightly. The yeast-like germ that causes the rash is commonly found on the skin, and usually does no harm. For reasons that are not clear, it seems that the germ multiplies more easily to cause a rash on certain people. The treatment for pityriasis versicolor consists of: Ketoconazole shampoo (2%) is commonly advised. You can buy this at pharmacies, and it is also available on prescription. Ketoconazole kills the germ that causes this rash. Apply the shampoo neat to affected areas, and then wash off after five minutes. Repeat each day for five days. Some doctors advise that you should then apply the shampoo about once a week for six months to try and clear the skin completely of the germ. Selenium sulphide shampoo is an alternative. It is not strictly licensed for the treatment of this rash, but it works. You can buy it from pharmacies. Dilute the shampoo with water 50:50 (half water, half shampoo). Then apply the diluted shampoo to the affected areas. Leave to dry, and wash off in 24 hours. Apply twice a week for four weeks. An antifungal cream is an alternative. You can buy these at pharmacies, and they are also available on prescription. (Yeasts are similar to fungus germs, and antifungal creams also kill yeasts.) Anti-fungal tablets may be prescribed if the rash is over a large area of your skin, or is not cleared by the above treatments. Note: after treatment, the colour of the affected skin usually takes 3-6 months to return to normal. Some people seem prone to this yeast-like germ multiplying on their skin, and the rash may recur after treatment. One option is to apply one of the above shampoos to your skin every 2-4 weeks. This may keep the germ away, or prevent the numbers building up, which will prevent the rash from recurring.