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For further information, see CMDT Part 6-14: Fungal Infections of the Skin

Key Features

Essentials of Diagnosis

  • Marked itching in intertriginous areas, usually sparing the scrotum

  • Peripherally spreading, sharply demarcated, centrally clearing erythematous lesions

  • May have associated tinea infection of feet or toenails

  • Laboratory examination with microscope or culture confirms diagnosis

General Considerations

  • Tinea cruris lesions are confined to the groin and gluteal cleft

  • Intractable pruritus ani may occasionally be caused by a tinea infection

Clinical Findings

Symptoms and Signs

  • Itching may be severe, or the rash may be asymptomatic

  • Typical lesions are erythematous and sharply demarcated, with central clearing and active, spreading scaly peripheries

  • Follicular pustules are sometimes encountered

  • The area may be hyperpigmented on resolution

Differential Diagnosis

  • Other lesions of the intertriginous area

    • Erythrasma: best diagnosed with Wood light—a brilliant coral-red fluorescence is seen

    • Candidiasis

      • Generally bright red and marked by satellite papules and pustules outside of the main border of the lesion

      • Candida typically involves the scrotum

    • Seborrheic dermatitis: also often involves the face, sternum, and axillae

    • Intertrigo

      • Tends to be less red, less scaly

      • Tends to be present in obese individuals in moist body folds with less extension onto the thigh

    • Psoriasis of body folds ("inverse psoriasis")

      • Inverse psoriasis is characterized by distinct plaques

      • Other areas of typical psoriatic involvement should be checked

      • The KOH examination will be negative

Diagnosis

Laboratory Tests

  • Hyphae can be demonstrated microscopically in KOH preparations

  • The organism may be cultured

Treatment

Medications

General measures

  • Drying powder (eg, miconazole nitrate [Zeasorb-AF]) can be dusted into the involved area in patients with excessive perspiration or occlusion of skin due to obesity

Local measures

  • See preparations listed in Table 6–2

  • Terbinafine cream is curative in over 80% of cases after once-daily use for 7 days

Systemic measures

  • Itraconazole, 200 mg once daily orally, or terbinafine, 250 mg once daily orally, for 1 week, can be effective

  • Griseofulvin ultramicrosize is reserved for severe cases; give 250–500 mg twice daily orally for 1–2 weeks

Outcome

Prognosis

  • Usually responds promptly to treatment but often recurs

When to Refer

  • If there is a question about the diagnosis, if recommended therapy is ineffective, or if specialized treatment is necessary

Reference

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van Zuuren  EJ  et al. Evidence-based topical treatments for tinea cruris and tinea corporis: a summary of a Cochrane systematic review. Br J Dermatol. 2015 Mar;172(3):616–41.
[PubMed: ...

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