Blog Article: From Viral Rash to Nail Fungus – Treating Molluscum and Onychomycosis in Katy & Houston, TX
By: Dr. Ashley Baldree
Introduction
At Village Dermatology, we see a wide variety of skin conditions, from viral rashes to fungal nail infections. In this case, a 42-year-old man from Katy, Texas presented with two common dermatologic concerns: a bumpy rash in the underarm area and a chronic fungal nail infection. This blog post shares how our team accurately diagnosed and effectively treated both conditions using evidence-based, patient-focused care.
Case Overview
Patient: 42-year-old male
Complaints:
Rash in the axilla (underarm area) for 2 weeks
Toenail infection for over 1 year
He was not on any prescription medications, though he had attempted to self-treat the nail issue using over-the-counter antifungal products with limited success.
Diagnosis 1: Molluscum Contagiosum
The underarm rash was diagnosed as Molluscum Contagiosum, a viral skin infection caused by a poxvirus. It presents as pink, umbilicated (dimpled) bumps, often spread through skin-to-skin contact or shared water sources like pools. In this case, the patient’s children also had molluscum, supporting a diagnosis of household transmission.
Affected areas:
Left axilla
Rib cage
Posterior axilla
Lateral chest
Treatment: Liquid Nitrogen Cryotherapy
The patient chose cryotherapy with liquid nitrogen (LN2)—a quick and effective method to destroy molluscum lesions. We treated 57 lesions in total using two freeze-thaw cycles per site.
Post-treatment counseling included:
Possible side effects: blistering, pigment changes, recurrence
Hygiene and skin care tips
What to do if lesions worsen or spread
Follow-up: Scheduled in 4 weeks to monitor progress and consider topical tretinoin if needed.
Diagnosis 2: Onychomycosis (Toenail Fungus)
The second complaint involved a discolored, dystrophic left toenail, which began after trauma during a softball tournament. Clinical exam revealed superficial onychomycosis, a common fungal nail infection.
Treatment Plan: Topical Tolcylen
Given the superficial nature of the infection, the patient was prescribed Tolcylen, a medical-grade topical antifungal that penetrates the nail plate. Oral medications offer higher cure rates but carry risks such as liver toxicity and bone marrow suppression.
Key patient education:
Topicals often require prolonged use and may not always cure the infection
Oral antifungals are more effective but not without potential serious side effects
50% of patients experience recurrence even after successful treatment
Follow-up: 4 weeks for reassessment of nail and skin conditions
Why This Matters in Katy & Houston, Texas
Common dermatologic issues like molluscum contagiosum and toenail fungus can easily be misdiagnosed or undertreated. At Village Dermatology, we provide accurate diagnostics, thorough patient education, and personalized care plans—from pediatric infections to adult fungal conditions.
