Got this itchy red patch on my elbow that won't go away even with moisturizer. Been dealing with it for about three weeks now. It's driving me crazy and I'm not sure if I need antifungal cream or if it's just my eczema acting up again.
Fungal infections tend to have a defined border that's sharp and maybe slightly raised, while eczema usually fades more gradually into normal skin - though honestly the only way to be totally sure is getting a doctor to look at it since they can do a quick test right there.
If you've already got a history of eczema flaring up it's tempting to self-treat, but three weeks with no improvement from regular moisturizer is worth the five minutes it takes to get it actually identified.
The best way to know for sure is honestly just to get it checked by a derm or your doctor - they can do a quick scraping or look under a microscope if needed. But there are some things you can pay attention to before you make that appointment. Fungal infections tend to have that really sharp, defined border that doesn't blur into the surrounding skin, and they often feel kind of scaly or almost leathery. Eczema is usually more of a gradual fade into normal skin, tends to be drier and itchier, and often shows up in clusters or patches that spread irregularly.
I dealt with this exact thing on my shoulder a couple years back. I was convinced it was my usual eczema flare because I get that in winter, but three weeks of my normal routine - ceramide moisturizer, avoiding irritants - didn't touch it. The thing that made me realize it wasn't my usual eczema was that it was almost weeping a little bit and had this kind of darker, more defined ring around it. Went to my doctor, turned out to be ringworm (which is ironic because I spend so much time at the gym), and the antifungal cream cleared it up in like two weeks. So yeah, if something's not responding to your normal eczema routine after a few weeks, that's your sign to get it looked at.
One thing worth trying in the meantime: keep the area completely dry and don't cover it up with thick creams. If it's fungal, moisture can actually make it spread. If you're dealing with eczema, you'd normally want to moisturize more, so that difference can actually help you figure out what's going on before you see someone. But don't self-treat with antifungal cream if you're not sure - that won't help eczema and you might just delay getting actual treatment.
Three weeks is long enough that you should probably just bite the bullet and see a doctor about it. They can do a simple scraping or KOH test to tell the difference in minutes, and it'll save you money on creams you might not need. That said, there are some things worth noticing while you're waiting for an appointment.
Fungal infections tend to spread outward in a pattern - the border is usually pretty obvious and sometimes you'll see a raised or scaly edge. Eczema patches are typically more irregular and often show up in places you've had flare-ups before. If it's fungal, you might notice it's getting slightly worse or moving around, whereas eczema usually stays in the same spot and feels more like general inflammation. Also, fungal stuff sometimes gets worse when you keep it moist with heavy creams (which actually feeds the fungus), while eczema needs moisture to improve.
In the meantime, keep the area clean and dry, avoid heavy occlusive moisturizers, and don't scratch it even though I know that's easier said than done. If you absolutely can't see a doctor right away, antifungal cream won't hurt to try - it won't make eczema worse. But since you've already had eczema before, you probably know what that flare-up pattern feels like, and three weeks of something new is worth getting checked properly.
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