A 59-year-old man presents with itching in the groin (Figure 139-1). On examination, he was found to have scaly erythematous plaques in the inguinal area. A skin scraping was treated with Swartz-Lamkins stain and the dermatophyte was highly visible under the microscope (Figure 139-2). He was treated with a topical antifungal medicine until his tinea cruris resolved.
Tinea cruris in a 59-year-old Hispanic man present for 1 year. (Courtesy of Richard P. Usatine, MD.)
Microscopic view of the scraping of the groin in a man with tinea cruris. The hyphae are easy to see under 40 power with Swartz-Lamkins stain. (Courtesy of Richard P. Usatine, MD.)
Tinea cruris is an intensely pruritic superficial fungal infection of the groin and adjacent skin.
Crotch rot and jock itch.
- Using data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey (NHAMCS) (1995-2004), there were more than 4 million annual visits for dermatophytoses and 8.4% were for tinea cruris.1
- Tinea cruris is more common in men than women (three-fold) and rare in children.
- Most commonly caused by the dermatophytes: Trichophyton rubrum, Epidermophyton floccosum, Trichophyton mentagrophytes, and Trichophyton verrucosum. T. rubrum is the most common organism.2
- Can be spread by fomites, such as contaminated towels.
- The fungal agents cause keratinases, which allow invasion of the cornified cell layer of the epidermis.2
- Autoinoculation can occur from fungus on the feet or hands.
- Wearing tight-fitting or wet clothing or underwear has traditionally been suggested; however, in a study of Italian soldiers, none of the risk factors analyzed (e.g., hyperhidrosis, swimming pool attendance) were significantly associated with any fungal infection.3
- Obesity and diabetes mellitus may be risk factors.4
The cardinal features are scale and signs of inflammation. In light-skinned persons inflammation often appears pink or red and in dark-skinned persons the inflammation often leads to hyperpigmentation (Figures 139-3 and 139-4). Occasionally, tinea cruris may show central sparing with an annular pattern as in Figure 139-5, but most often is homogeneously distributed as in Figures 139-3 and 139-4.
Tinea cruris in an older black man with hyperpigmentation secondary to the inflammatory response. A silvery scale is also seen and psoriasis should be considered in the differential diagnosis. In such a case, performing a potassium hydroxide preparation is crucial to making an accurate diagnosis as it is not possible to know the diagnosis by appearance only. (Courtesy of Richard P. Usatine, MD.)