Tinea Cruris: Bothersome Ringworm of the Groin

Tinea cruris, jock itch, ringworm of groin or whatever you name it, is the most common superficial fungal infection of the groin area and adjacent skin. Although can be seen throughout the year tinea cruris is most common during summer months. Male are at risk higher than females. Tinea cruris is not that serious problem and can be managed effectively by keeping the area clean, dry and applications of anti-fungal medications. However, recurrence is very common and this creates problem for most of the people.

Who is at Risk?

Tinea cruris is commonly seen in adolescent boys and adult men. Person having tinea cruris may also be having fungal infection on the foot and body (athlete’s foot and ringworm). It is common among the people who are obese and who sweats a lot, but can occur to anyone. It can be aggravated by repetitive friction in the groin area. It is contagious and can be spread through skin-skin contact or through unwashed clothing.

How is Tinea Cruris diagnosed?

Your doctor can diagnose the lesion based on direct examination and symptoms of the lesion. No other tests are generally necessary. If it creates confusion with other disease, your doctor may perform a quick KOH test to confirm or culture and biopsy as needed to exclude other diseases.

Other condition that can be confused with tinea cruris are:

Candida infection/Candidial intertrigo: Generally acute onset, usually bright red rash with satellite pustules surrounding the rash.

Inverse psoriasis: Chronic red scaly rash,Mild or no itch,often associated with rash elsewhere on body (scalp, knee,elbow,nails)

Erythrasma: Usually asymptomatic patches with dry, red to brown color.

Dermatitis: Several other dermatitis like seborrhoeic dermatitis, irritant contact dermatitis, allergic contact dermatitis

Symptoms of Tinea Cruris

Red, itchy, ring shaped rash in the groin area and adjacent skin is the most common presentation. The red patch is often associated with scales, small blisters and redness around the periphery while normal skin tone in the center. Both groins are commonly affected. The rash usually spreads few cm down inside to the thighs.

Treatment of Tinea Cruris

Several treatment options are available both over the counter and prescription medications. You can buy over the counter antifungal cream containing Butenafine, terbinafine, Tolnaftate, ketoconazole, clotrimazole, miconazole, econazole and apply on regular basis. Application of antifungal 2-3 times a day and maintaining the area clean and dry is usually sufficient in most cases.  Terbinafine in compared to other azoles is expensive but is the most effective medication, also requiring shorter treatment duration. If it doesn’t work you may need prescription antifungal creams.

How to apply antifungal for maximum result and to avoid recurrence

• Apply the cream to the affected area including surrounding 2-3 cm of normal skin.
• Apply for longer duration and continue applying even if the lesion has healed (you may adjust maintenance dose to once daily or alternate days for few weeks after lesion heals).
• Application may differ according to medication; see the leaflet for more detail on each medication.
• If there is inflammation, you doctor may also provide with mild steroids to subside the inflammation. Steroids will also soothe the itching and redness. Never use steroids for more than a week.

Oral antifungal may also be prescribed by your doctor if the infection is severe. Oral antifungals like terbinafine, fluconazole or itraconazole may be given by your doctor.

How can I prevent Tinea Cruris from recurring?

Although tinea cruris can be treated effectively by both over the counter and prescription medications, recurrence is very common. So, in order to prevent from recurring there are several things you have to keep in mind. Few are listed below:

• Wash your groin area daily with mild soap and dry thoroughly. It is very necessary to keep the area dry; fungi can grow faster and multiply in wet and moist environment.
• Change your underwear on daily basis; don’t give any change for fungus to multiply.
• Don’t wear underwear or any clothing that irritates the area. Avoid tight-fitting and rough-textured clothing.
• People often ignore and put on the underwear while the skin is still wet, never repeat such mistake.
• Check for fungal infection on other areas like foot (athlete’s foot) and treat it accordingly, if left untreated it can spread to the groin and other areas too.
• Never share private clothing and towels with other people. Always wash towel frequently and dry it in the sun daily after you use it.

Final Words

Tinea cruris usually responds well to treatment and complications are rare. However, if left untreated, secondary bacterial infection or even permanent darkening of the skin color may occur. So don’t wait and keep scratching, consult a dermatologist and get it treated.

Another condition called erythrasma can also occur on the same area and sometimes misdiagnosed. Erythrasma is caused by bacterial infection so applying anti-fungal won’t work.