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Updated: Sep 27 2017

Tinea Cruris

  • Snapshot
    • A 17-year-old boy presents to his pediatrician for evaluation of a rash in his genital area. He reports that it is very itchy and started about 1 week ago. At school, he participates in multiple sports, including wrestling with practice 3 times a week. He admits that he doesn’t always wash his hands and often delays showering after practice. On physical exam, there are multiple 3-5 cm annular and pink plaques on inner thighs and groin. His scrotum is clear. He is given a topical treatment for his rash.
  • Introduction
    • Clinical definition
      • superficial fungal infection of the skin of the groin or inner thighs
        • a type of dermatophytosis
        • also known as jock itch
    • 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
      • dermatophytes
        • Trichophyton
          • most commonly Trichophyton rubrum
        • Microsporum
        • Epidermophyton
    • Pathogenesis
      • fungus infects superficial keratinized tissue and invades stratum corneum and terminal hair
    • Associated conditions
      • tinea pedis
        • often the source of infection
      • onychomycosis
    • Prognosis
      • responsive to topical treatment
  • 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
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