Tinea cruris usually affects the inner thighs and genitals but can often spread to the perineum and perianal area. The acute infection begins as a series of sores in the groin region (each about half inch wide) which then take the appearance of a rash with sharply defined borders that can later blister and exude [8]. Patients report an intense itch in the affected body part (usually associated with a burning sensation) and a recent history of related episodes like visits to tropical countries or wearing tight-fitting clothes. People living in situations in which sharing is highly possible, for instance prison inmates, comrades in armed forces and members of athletic teams, have an additional risk of contracting the disease.

• Pain

  The infection is itchy and may be painful. It may spread to the penis and anus. Who Suffers from Tinea Cruris? If you are obese then you are more likely to suffer from tinea cruris. [mangoboss.com]

  Some individuals may have a burning pain in the rash area. When clothing rubs against the skin, additional discomfort and/or pain can occur. [medicinenet.com]

  Symptoms and Complications Tinea is often painful or itchy, but not in every case. There are visual clues to help identify a fungal infection. [medbroadcast.com]

• Asymptomatic

  Dermatophytes were isolated from clinically asymptomatic sites in 46% patients before treatment and in 21% of the patients on follow up. [ncbi.nlm.nih.gov]

  A 36-year-old man attended our clinic with slowly progressive, asymptomatic, annular skin lesions on both the thighs and buttocks for 10 years. [synapse.koreamed.org]

  […] nails; the invasion may be restricted to white patches or pits on the nail surface, or the lateral or distal edges of the nail may be involved first, followed by establishment of the infection beneath the nail plate. tinea versi´color a chronic, usually asymptomatic [medical-dictionary.thefreedictionary.com]

  The “id” reaction can be the only manifestation of an asymptomatic web space maceration. Tinea pedis is often treated with topical therapy. [aafp.org]

• Sepsis

  (MCC) DRG 872: SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MAJOR COMPLICATION OR COMORBIDITY (MCC) Total Hospitalizations at DRG 1,808,415 Total Hospitalizations with ICD B356 - Tinea cruris 1,817 DRG Share of Total Hospitalizations 5.5 [dexur.com]

  […] vagina  B37.4 - Candidiasis of other urogenital sites  B37.41 - Candidal cystitis and urethritis  B37.42 - Candidal balanitis  B37.49 - Other urogenital candidiasis  B37.5 - Candidal meningitis  B37.6 - Candidal endocarditis  B37.7 - Candidal sepsis [slideshare.net]

  Invasive Candidiasis As a Cause of Sepsis in the Critically Ill Patient. Virulence. 2014; 5:1, 161–169. Centers for Disease Control and Prevention (December 4, 2015 updated.) Ringworm. [labtestsonline.org]

• Nausea

  Nausea was reported by two patients and an urticarial reaction was seen in one patient after 8 days treatment. This latter patient discontinued therapy because of the adverse experience. [ncbi.nlm.nih.gov]

  Side effects Common side effects of oral antifungal medicines include: nausea; diarrhoea; headache; and indigestion. Some oral antifungal medicines are not suitable for use in certain people. [mydr.com.au]

  Adverse reactions to terbinafine may include: Nausea, a feeling of fullness Diarrhoea, abdominal pain A headache Dizziness. Painful muscles and joints Taste disturbance, loss of appetite (uncommon, <1%). Liver disease (rare, <0.01%). [dermnetnz.org]

• Vomiting

  Nausea and vomiting (5%) Constipation Headache Dizziness Abnormal liver function tests (up to 5% for those on long term therapy, 2% for pulse therapy); significant liver disease is rare Allergic skin rash including urticaria Endocrine effects including [dermnetnz.org]

  […] after two weeks of treatment Does not go away completely or comes back frequently despite proper prevention When to go to the hospital Go to a hospital's emergency department if you develop any of the following symptoms beyond the rash: Fever Weakness Vomiting [emedicinehealth.com]

  Patients who are taking ketoconazole should be instructed to immediately report symptoms of hepatotoxicity such as anorexia, nausea and vomiting. [aafp.org]

• Diarrhea

  Travelers in endemic areas with poor sanitation have also experienced intestinal overgrowth with Candida, although the specific mechanism causing diarrhea is unknown.14 Candida-associated diarrhea is predominantly of the secretory type, characterized [labcorp.com]

  Possible side effects: nausea, lamisil dermgel cena upset stomach, diarrhea (can sometimes be avoided by taking with food or by using the extended-release formulations). Any questions? เครื่องวัดประสิทธิภาพ. [cornersgallery.com]

  […] topical, applied twice daily until rash resolves, or oral, 250 mg four times daily for two weeks). 3, 17, 18 Oral erythromycin is more effective than a topical regimen, but it can cause adverse reactions, such as nausea, vomiting, abdominal pain, and diarrhea [aafp.org]

  This is a reactive condition developing due to chronic irritant contact dermatitis caused by urinary incontinence or chronic diarrhea. 63, 89, 91 Diagnosis is generally straightforward, and biopsy may be required to rule out mast cell tumors, pseudolymphoma [ncbi.nlm.nih.gov]

• Pruritus Ani

  See also Antifungal drugs Pruritus ani Ringworm Reference External links eMedicine Health MayoClinic - jock itch Links to jock itch pictures (Hardin MD/Univ of Iowa) How to Prevent Jock Itch with Rubbing Alcohol nl:Tinea cruris [wikidoc.org]

  Yet another comment asked about the difference between “anogenital region” (noted in DC 7829) and “pruritus ani” (DC 7337), and whether these ratings may be combined. [federalregister.gov]

• Heart Disease

  If, however, it causes heart disease, it is rated under code 7005, arteriosclerotic heart disease. – Hypersomnia is a condition where you are excessively tired during the day. [militarydisabilitymadeeasy.com]

• Visual Impairment

  If there is also a decrease in normal vision, however, then that can be rated under the Visual Impairment Rating System. – Osgood-Schlatter’s Disease is a condition where the knob at the top of the tibia just below the knee swells. [militarydisabilitymadeeasy.com]

• Intertrigo

  Intertrigo is another possible diagnosis that can be confused with tinea cruris, but in intertrigo, the KOH preparation, or fungal culture, will be negative. [somalaser.com]

  scrot rot[1][2]: 303  Tinea cruris on the groin of a man Specialty Dermatology Symptoms Itch, rash in groin Risk factors Excessive sweating Diabetes Obesity Diagnostic method Microscopy and culture of skin scrapings Differential diagnosis Candidal intertrigo [en.wikipedia.org]

  These results point to important predisposing factors for the susceptibility to candidal intertrigo and tinea cruris respectively. [ncbi.nlm.nih.gov]

  The first is called intertrigo, which is a red, macerated rash at the groin fold that's not caused by a fungus. Intertrigo commonly occurs in people who are obese and is caused by moist skin rubbing against other moist skin. [verywellhealth.com]

  Tinea cruris Tinea cruris can be confused with other forms of intertrigo such as: Candida Erythrasma Psoriasis Seborrhoeic dermatitis Tinea cruris quite often recurs after apparently successful treatment. [dermnetnz.org]

• Erythema

  The results showed that butenafine causes rapid resolution of signs and symptoms (erythema itching, burning, crusting, scaling, etc), with good patient and physician acceptability of treatment. [ncbi.nlm.nih.gov]

  The erythema and scale tends to be most pronounced at the leading edge of the rash. [pcds.org.uk]

• Pruritus

  Intense pruritus (itching) is common. Localised scrotal infection is quite common and inconspicuous. There may be evidence of superficial fungal infection elsewhere on the body. [life-worldwide.org]

  After clinical evaluation of redness, scaling, pruritus and burning/pain sensation and mycological assessment, honey mixture containing honey, olive oil and beeswax (1:1:1) was applied to the lesions three times daily for a maximum of 4 weeks. [ncbi.nlm.nih.gov]

• Skin Rash

  Diagnosis Your doctor often can make the diagnosis just by looking at the rash. Your doctor may gently scrape the skin to get a sample to look for fungi under the microscope. [health.harvard.edu]

  Signs and Symptoms: Red itchy rash or bumps in folds of the skin Rash may appear circular or have small blisters Itching or burning of the skin Scaling or flaking of the skin Treatment: Over the counter topical creams, lotions and powders are available [shs.uncg.edu]

  Symptoms of jock itch include the following: An itchy red rash that is slightly raised and flaking Crack formations in the skin Often, the skin rash will have a sharp line that defines the extent of the ongoing infection. [medicinenet.com]

• Eruptions

  G., a white youth, aged 17, a student, was seen on Jan. 17, 1930, with an eruption in the axillae, around the navel and on the thighs near the scrotum. The disease began on the thighs about two weeks before. [jamanetwork.com]

  Dermatology Infections: Fungal--Clinical Symptoms and Signs This patient has two skin eruptions: 1) Tinea cruris that is in the inguinal folds and near the edge of the scrotum, and 2) An irritant dermatitis on the more distal portion of his thighs. [library.med.utah.edu]

  The eruption had been present for 2 to 3 weeks. A potassium hydroxide( preparation revealed fungal elements. Unlike a Candida infection of the groin, tinea cruris usually is more confined and spares the scrotum. [consultant360.com]

  The Tinea was localized on the groin and it presented as erythematous eruptions with hyper pigmented. He had unbearable itching and burning sensation and the tinea was gradually spreading. [askdrshah.com]

  International Classification of Diseases, Tenth Revision, Clinical Modification.B35.6 Tinea cruris and Tinea cruris B35.2 Tinea manuum due to Trichophyton mentagrophytes variant interdigitale B35.9 Ide eruption due to tinea [averbis.com]

• Irritability

  […] clothing depends on severity, keep skin clean and dry, avoid irritating clothing, drying powder containing micanozole. [quizlet.com]

  A doctor may scrape a small piece of irritated skin and examine it under a microscope. Sometimes, a doctor may send a skin sample to a laboratory to determine what is causing the skin irritation. [rxhealthmed.ca]

• Burning Sensation

  There is often an itching, burning sensation in the infected area. The disease is most active at the edges of the patch. What can be done at home? Good general hygiene is vital in order to prevent tinea cruris. [netdoctor.co.uk]

  Adverse events definitely related to butenafine treatment were limited to one case of burning sensation after application. CONCLUSION: Butenafine applied once daily for 2 weeks is effective in treating tinea cruris. [ncbi.nlm.nih.gov]

  This is followed by burning sensations. Rashes are ring-shaped about an inch in size, light red or pink color at first. Later the rash may become dry or bumpy or possibly have pus that seeps out. [allhealthsite.com]

  There may be a burning sensation in the affected region. The skin appears to be flaking peeling or cracking. Patients suffering from ringworm of the groin find it uncomfortable to wear underwear. Walking and exercising also aggravates the rash. [ringworm-treatment.net]

The main diagnostic method for tinea cruris is microscopy, usually with the use of potassium hydroxide (KHO) to help dissolve keratin and other debris. The specimen can then be sent to a laboratory to confirm or identify the fungal species responsible for the infection. Rarely, biopsy might be needed in atypical cases which do not properly respond to treatment.

• Trichophyton Rubrum

  […] caused by trichophyton rubrum tinea cruris clinical characteristics infection of skin of the groin, could spread to the butt. cosmopolitan, more in common tropics. 3x more common in men then women. large populations of people. tinea cruris predisposing [quizlet.com]

  Most common causative pathogen is Trichophyton rubrum (2). There is often spread of the infection from the groins to involve the lower abdomen, scrotum and buttocks. Often patients complain of burning and pruritus (2). [gpnotebook.co.uk]

  […] gallinae|Tinea cruris caused by Trichophyton gallinae (disorder)|Tinea cruris caused by Trichophyton rubrum|Tinea cruris caused by Trichophyton rubrum (disorder)|Tinea cruris due to Epidermophyton floccosum|Tinea cruris due to Trichophyton gallinae|Tinea [averbis.com]

  In New Zealand, Trichophyton rubrum and Epidermophyton floccosum are the most common causes. Infection often comes from the feet ( tinea pedis ) or nails ( tinea unguium ) originally, spread by scratching or the use of an infected towel. [dermnetnz.org]

Tinea cruris can be best treated by using antifungal medications of the imidazole or allylamine family (e.g. terbinafine and naftifine) [9][10]. Topical steroids and Whitfield’s ointment can be also used but their benefits are still not clear and they are not recommended by specialized guidelines [11]. Prevention is highly advised especially in those individuals with a history of dermatophyte infections on feet and hands.

Usually, the prognosis of tinea cruris is excellent but the risk of recurrence is very high. Therefore, subjects who have been affected by this infection are advised to take the appropriate precautions like daily groin washing, frequent underwear change and especially constant check of the feet as the skin between the toes is flaky and thus, more inclined to fungal infections.

This is a classical example of opportunistic infection which takes advantage of any temporary or permanent weakness of the immune system. The most common etiologic agents of tinea cruris are the species which normally live on the surface of the epidermis causing no problem in immunocompetent people. Notable among them are Trichophyton rubrum and Epidermophyton floccosum. These fungi may also grow on non-living objects (called fomites) such as towels, bedroom sheets and especially skin-tight garments like jock straps [2]. 

In addition to immune weakness, a number of other circumstances (like remaining in sweat-soaked clothes or experiencing a prolonged exposure to moisture after a workout or a game) can also favor the growth of these fungi. The humid conditions generated in these accidental situations favor the overgrowth of the fungal population which ultimately enters the superficial epidermal layers and leads to infection. The common name “jock itch” might give the false impression that this is a problem which only involves athletes.

Overweight people are frequently affected as the numerous folds of their skin offer a perfect environment for fungal growth. Wearing tight clothing also contributes to the development of tinea cruris because it causes sweating and prevents the skin from drying.

Like all the other members of the dermatophytosis family, tinea cruris is common all over the world; especially in countries with hot humid climates where it finds the perfect conditions to thrive [3][4][5].

While no mortality is associated with this disease, the morbidity is quite high and can be attributed to complications like lichenification, secondary bacterial infections and dermatitis. Tinea cruris is three times more frequent in men than in women. It is also more common in adults compared to children owing to scrotal anatomy and age-related disorders like obesity and diabetes mellitus.

The most common etiologic agents responsible for tinea cruris are the species belonging to the genus Trichophyton and the species Epidermophyton floccosum and Microsporum canis. They produce keratins that favor the invasion of the epidermal cornified layer. The infection is then encouraged by the damp and warm conditions of local environments like those within the above mentioned folds of the skin [6] [7]. Tinea cruris can be transmitted through anthropophilic, geophilic and zoophilic spread. It most frequently infects the groin and its adjacent areas.

The main recommendation to prevent tinea cruris is to always maintain good standards of hygiene for nails and skin, especially in the groin area which should be kept clean and dry by drying off after bathing and putting on dry clothing after athletic activities. It is also recommended to wear loose cotton underwear and avoid the aforementioned tight-fitting clothes together with using antifungal powders and avoding the sharing of clothes and towels [11][12].

Tinea cruris can be acute, subacute or chronic and is specifically located between the intertriginous folds in the area around the groin, scrotum and less frequently the penis, vulva and anus. The infection affects both sexes - though it is more often seen in adult men. Like the other types of dermatophytosis, tinea cruris tends to grow with a characteristic ring-like pattern on the skin for which it is often referred to as ringworm.

Tinea Cruris is a skin infection of the area of the groin and adjacent skin in any sex. It tends to grow onward on the skin, producing a characteristic ring-like pattern, and characterizes itself to take advantage of temporary favourable conditions such as a weakening of the immune system.

The most common etiologic agents of tinea cruris are the species of fungi which live on the surface of the skin. These organisms thrive in the favorable hot humid conditions generated in accidental situations like wearing tight clothing and experiencing a prolonged exposure to moisture. In these occasions, fungi can enter the superficial epidermal layers and cause infection.

Tinea cruris can be easily treated by using antifungal medications, but recurrence is very frequent and appropriate precautions like using antifungal powders should always be employed.

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2. “Causes of Jock Itch." Retrieved 2013-01-06.
3. Sadri MF, Farnaghi F, Danesh-Pazhooh M, Shokoohi A. “The frequency of tinea pedis in patients with tinea cruris in Tehran, Iran.” Mycoses. 2000; 43(1-2):41-4.
4. Yehia MA, El-Ammawi TS, Al-Mazidi KM, Abu El-Ela MA, Al-Ajmi HS. “The Spectrum of Fungal Infections with a Special Reference to Dermatophytoses in the Capital Area of Kuwait During 2000-2005: A Retrospective Analysis.” Mycopathologia. Nov 17 2009.
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6. Rashid R et al; Tinea in Emergency Medicine, Medscape, Mar 2011.
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8. “Jock itch." MedlinePlus. NLM / NIH.
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10. El-Gohary, M; van Zuuren, EJ; Fedorowicz, Z et al (Aug 4, 2014). "Topical antifungal treatments for tinea cruris and tinea corporis." The Cochrane database of systematic reviews 8: CD009992.
11. "Jock itch." Crutchfield Dermatology.
12. "Jock Itch Causes, Symptoms and Treatment." Everydayhealth. Harvard Health Publications.