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Tinea Cruis: A Bothersome Male Condition
JNP
Tinea Cruis: A Bothersome Male Condition Tinea cruris, commonly referred to as “jock itch,” is a dermatophyte infection that presents in the groin and inner thigh.1 This dermatophyte infection is a superficial fungal infection of the skin. Dermatophyte infections affect 1 of 5 Americans.2 The estimated lifetime risk of acquiring a dermatophyte infection is 10% to 20%.1 Tinea cruris presents in men more often than in women, with a gender disparity of 4:1.2 Other predisposing factors are tightly fitting clothing, summer months, climates with high humidity and moisture, obesity, and corticosteroid use.2
MEN’S HEALTH Demetrius J. Porche
ETIOLOGY AND CLINICAL PRESENTATION The common causative agents for tinea cruris are Trichophyton rubrum, Trichophyton mentagrophytes, and Epidermophyton floccosum.1 These are also the causative organisms for tinea pedis (athlete’s foot). Infection with tinea cruris can occur through autoinoculation with transfer from the feet to the groin area, generally from the feet being dried first after bathing and the organisms being transferred to the groin area by the towel. These infections can be transmitted by other routes, such as contaminated clothing and towels. These organisms also can be transmitted from person to person. These infections are transmitted from environments such as public floors, public showers, locker rooms, and damp surfaces.1,2 Tinea cruris presents primarily in the upper and inner thigh, inguinal folds, perineal area, and buttocks. The typical skin lesion consists of a pruritic ringed plaque. There are clearly demarcated margins with scaling. Small papules or 84
pustules may be present at the outer edges of the demarcated plaque. The plaques typically present bilaterally.1
DIAGNOSIS Tinea cruris is typically diagnosed based on history and clinical presentation. The differential diagnosis should consider Candida intertigo, contact dermatitis, erythrasma, psoriasis, and seborrhea.1 Microscopy can be used to definitively diagnose tinea cruris. The plaques can be scraped, with the specimen placed in potassium hydroxide solution for microscopic examination. The presence of hyphae confirms the diagnosis of a dermatophyte infection. Dermatophytes that cause tinea cruris do not fluoresce with a Wood light examination. Cultures can be performed but are considered an expensive and time-consuming practice for this diagnosis.1 Repeated presentation should alert the nurse practitioner to other potential comorbidities, such as immune deficiency and diabetes mellitus.
CLINICAL MANAGEMENT Tinea cruris can be managed with nonprescription topical antifungal agents. Common agents used in the treatment of tinea infections are butenafine, clotrimazole, miconazole, terbinafine, and tolnaftate.2 Lotions are optimal February 2006
for treating moist, oozy, weepy lesions. Creams are optimal for treating scaling, nonoozing lesions. Powders are less effective but decrease the amount of moisture and maceration in the affected area. Oral antifungal agents are generally limited to cases that do not respond to topical antifungal agents. Client education is an essential component of the clinical management of tinea cruris. Infections can be prevented, and client instruction to prevent infections should include: • Wearing lose undergarments • Wearing undergarments only once before laundering • Changing undergarments frequently, especially after work or after periods of being hot and sweaty • Bathing or showering immediately after a workout • Using different towels to dry the feet and groin area • Applying talc or another drying powder to the groin area • Cleaning towels regularly and not storing damp clothing or towels in lockers or bags • Washing workout clothing after each wearing • Sleeping nude or in a loosely fitting nightshirt • Walking in public areas with shoes or water shoes • Placing socks on feet before putting on undergarments • Treating tinea pedis quickly and effectively
SUMMARY Tinea cruris—a bothersome, preventable fungal infection that affects men more than it affects women—is easily diagnosed and clinically managed with nonprescription medications. References 1. Noble SL, Forbes RC, Stamm PL. Diagnosis and management of common tinea infections. Am Fam Phys. 1998;58(1):163-174, 177178. 2. Pray WS, Pray JJ. Tinea cruris in men: bothersome but treatable. US Pharm. 2005;8:13-17.
Demetrius J. Porche, DNS, RN, APRN, is a professor, director of the Doctor of Nursing Science Program, and associate dean of the School of Nursing at Louisiana State University in New Orleans, La. He can be reached at [email protected]. 1555-4155/06/$ see front matter © 2006 Elsevier Inc. All rights reserved. doi:10.1016/j.nurpra.2005.12.017
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Tinea Cruis: A Bothersome Male Condition Tinea cruris, commonly referred to as “jock itch,” is a dermatophyte infection that presents in the groin and inner thigh.1 This dermatophyte infection is a superficial fungal infection of the skin. Dermatophyte infections affect 1 of 5 Americans.2 The estimated lifetime risk of acquiring a dermatophyte infection is 10% to 20%.1 Tinea cruris presents in men more often than in women, with a gender disparity of 4:1.2 Other predisposing factors are tightly fitting clothing, summer months, climates with high humidity and moisture, obesity, and corticosteroid use.2
MEN’S HEALTH Demetrius J. Porche
ETIOLOGY AND CLINICAL PRESENTATION The common causative agents for tinea cruris are Trichophyton rubrum, Trichophyton mentagrophytes, and Epidermophyton floccosum.1 These are also the causative organisms for tinea pedis (athlete’s foot). Infection with tinea cruris can occur through autoinoculation with transfer from the feet to the groin area, generally from the feet being dried first after bathing and the organisms being transferred to the groin area by the towel. These infections can be transmitted by other routes, such as contaminated clothing and towels. These organisms also can be transmitted from person to person. These infections are transmitted from environments such as public floors, public showers, locker rooms, and damp surfaces.1,2 Tinea cruris presents primarily in the upper and inner thigh, inguinal folds, perineal area, and buttocks. The typical skin lesion consists of a pruritic ringed plaque. There are clearly demarcated margins with scaling. Small papules or 84
pustules may be present at the outer edges of the demarcated plaque. The plaques typically present bilaterally.1
DIAGNOSIS Tinea cruris is typically diagnosed based on history and clinical presentation. The differential diagnosis should consider Candida intertigo, contact dermatitis, erythrasma, psoriasis, and seborrhea.1 Microscopy can be used to definitively diagnose tinea cruris. The plaques can be scraped, with the specimen placed in potassium hydroxide solution for microscopic examination. The presence of hyphae confirms the diagnosis of a dermatophyte infection. Dermatophytes that cause tinea cruris do not fluoresce with a Wood light examination. Cultures can be performed but are considered an expensive and time-consuming practice for this diagnosis.1 Repeated presentation should alert the nurse practitioner to other potential comorbidities, such as immune deficiency and diabetes mellitus.
CLINICAL MANAGEMENT Tinea cruris can be managed with nonprescription topical antifungal agents. Common agents used in the treatment of tinea infections are butenafine, clotrimazole, miconazole, terbinafine, and tolnaftate.2 Lotions are optimal February 2006
for treating moist, oozy, weepy lesions. Creams are optimal for treating scaling, nonoozing lesions. Powders are less effective but decrease the amount of moisture and maceration in the affected area. Oral antifungal agents are generally limited to cases that do not respond to topical antifungal agents. Client education is an essential component of the clinical management of tinea cruris. Infections can be prevented, and client instruction to prevent infections should include: • Wearing lose undergarments • Wearing undergarments only once before laundering • Changing undergarments frequently, especially after work or after periods of being hot and sweaty • Bathing or showering immediately after a workout • Using different towels to dry the feet and groin area • Applying talc or another drying powder to the groin area • Cleaning towels regularly and not storing damp clothing or towels in lockers or bags • Washing workout clothing after each wearing • Sleeping nude or in a loosely fitting nightshirt • Walking in public areas with shoes or water shoes • Placing socks on feet before putting on undergarments • Treating tinea pedis quickly and effectively
SUMMARY Tinea cruris—a bothersome, preventable fungal infection that affects men more than it affects women—is easily diagnosed and clinically managed with nonprescription medications. References 1. Noble SL, Forbes RC, Stamm PL. Diagnosis and management of common tinea infections. Am Fam Phys. 1998;58(1):163-174, 177178. 2. Pray WS, Pray JJ. Tinea cruris in men: bothersome but treatable. US Pharm. 2005;8:13-17.
Demetrius J. Porche, DNS, RN, APRN, is a professor, director of the Doctor of Nursing Science Program, and associate dean of the School of Nursing at Louisiana State University in New Orleans, La. He can be reached at [email protected]. 1555-4155/06/$ see front matter © 2006 Elsevier Inc. All rights reserved. doi:10.1016/j.nurpra.2005.12.017
www.npjournal.org
Sign up to receive a FREE subscription, plus FREE access to the online version of the journal.*
Visit www.npjournal.org today! * npjournal.org is open to all visitors through December 31, 2005. Request your free subscription today to ensure continued access. 85