Dear Elisa,

This sounds like a very extensive and unusual "ringworm".  I think that
there are other diagnosis that could be considered such as psoriasis,
contact dermatitis, numular eczema or even pityriasis rosea or inversus.
Was a fungal scraping done to confirm this diagnosis?  Ketoconazole is a
heavy duty oral antifungal which can produce idiosyncratic hepatocellular
dysfunction and effects on various hormones.  I would like to be very sure
of the diagnosis before commencing a long term treatment regimen in any
patient, let alone a lactating mother.

Shirley Gross M.D.,C.M., C.C.F.P.
Edmonton Breastfeeding Clinic