Updated: 12/16/2021

Tinea Cruris

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  • Snapshot
    • A 20-year-old overweight woman presents to her physician’s office for a rash. She reports to wearing tight jeans despite the hot, humid weather. Physical exam reveals several annular plaques with overlying scale and central clearing on her inner thighs. A skin scraping with KOH preparation reveals hyphae.
  • Introduction
    • Clinical definition
      • superficial fungal infection of the skin of the groin or inner thighs
        • also known as jock itch
    • Associated conditions
      • tinea pedis
        • often the source of infection
      • onychomycosis
  • Epidemiology
    • Incidence
      • 10-20% lifetime incidence
    • Demographics
      • adolescent and adult males
      • adult females who are overweight or wear tight jeans
    • Risk factors
      • close contact sports, such as wrestling
      • moist warm environment
      • immunocompromise
      • contact with infected animals
  • Etiology
    • Pathogenesis
      • fungus infects superficial keratinized tissue and invades stratum corneum and terminal hair
    • Dermatophytes
      • Trichophyton
        • most commonly Trichophyton rubrum
      • Microsporum
      • Epidermophyton
  • Presentation
    • Symptoms
      • primary symptoms
        • itch
    • Physical exam
      • can have single or multiple lesions
      • well-demarcated annular patches or plaques with central clearing with
        • scaling
        • diffuse erythema
      • location
        • inner thighs or groin
          • spares scrotum and mucosa
  • Studies
    • KOH preparation
      • skin scrapings at active edge of lesion mixed with KOH
      • presence of hyphae indicates fungal infection
    • Wood lamp
      • indications
        • to rule out erythrasma
          • coral-red fluorescence
    • Diagnostic criteria
      • diagnosis usually based on clinical history and physical exam
  • Differential
    • Erythrasma
      • coral-red fluorescence under Wood lamp
    • Cutaneous candidiasis
  • Treatment
    • Medical
      • topical therapy
        • indication
          • localized lesions
        • drugs
          • terbinafine 1%
            • approved for patients 12 years of age and older
          • clotrimazole 1%
            • approved for patients 2 years of age and older
          • ketoconazole 2%
      • oral therapy
        • indications
          • widespread disease
          • refractory disease
        • drugs
          • terbinafine
          • griseofulvin
  • Complications
    • Secondary bacterial infection
  • Prognosis
    • Responsive to topical treatment
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