Tinea Cruris

A clinically typical, localized groin eruption may be managed empirically, but perform direct microscopy when the eruption is atypical, recurrent, extensive, steroid-modified, or has not improved with an adequate topical course. Collect scale from the active peripheral border rather than macerated central skin; visible hyphae on potassium hydroxide (KOH) examination support dermatophyte infection. ScienceDirect+1ScienceDirectTinea cruris - an overview | ScienceDirect TopicsCDCClinical Overview of Ringworm | Ringworm | CDC

A negative KOH result does not exclude tinea when sampling is poor or prior antifungal therapy has reduced recoverable material. In tinea pedis studies, KOH sensitivity and specificity varied substantially according to the reference standard; discordance among clinical assessment, KOH, and culture can reflect sampling error and culture-handling limitations. Repeat sampling from an untreated active edge or send fungal culture when the result will change treatment. Wiley+1WileyThe Sensitivity and Specificity of Potassium Hydroxide Smear and Fungal Culture Relative to Clinical Assessment in the Evaluation of Tinea Pedis: A Pooled Analysis - Levitt - 2010 - Dermatology Research and Practice - Wiley Online LibraryScienceDirectFrequency of Culture-Proven Dermatophyte Infection in Patients with Suspected Tinea Pedis - ScienceDirect

Culture is most useful before systemic therapy for recalcitrant disease, before labeling an eruption antifungal-resistant, and when an emerging dermatophyte is plausible. Request dermatophyte identification and antifungal susceptibility testing through a laboratory able to perform these services; species identification and susceptibility testing guide therapy in potentially resistant dermatophytosis. CDCCDCRecognition of Antifungal-Resistant Dermatophytosis by Infectious ...

Prioritize candidal intertrigo, erythrasma, irritant or allergic contact dermatitis, psoriasis, seborrheic dermatitis, and secondary Candida infection in chronic groin disease. Diagnostic uncertainty should trigger KOH examination from the lesion edge; dermatophyte hyphae support tinea, whereas erythrasma is distinguished clinically by coral-colored fluorescence under ultraviolet light. ScienceDirect+1ScienceDirectTinea Cruis: A Bothersome Male Condition - ScienceDirectScienceDirectTinea cruris - an overview | ScienceDirect Topics

In an obese patient with chronically moist, macerated folds, candidal superinfection may coexist with tinea cruris. If the eruption fails to clear, reassess the diagnosis and concurrent processes rather than assuming antifungal resistance; candidal intertrigo, dermatitis, and erythrasma require different management. ScienceDirectScienceDirectTinea cruris - an overview | ScienceDirect Topics

Steroid exposure is a high-value discriminator. Topical corticosteroids, including fixed antifungal-corticosteroid products, can worsen dermatophyte infection and blunt its recognizable inflammatory border. Stop the steroid-containing product, obtain mycologic testing from active scale when feasible, and treat the confirmed infection with an antifungal regimen rather than continued anti-inflammatory monotherapy. CDC+1CDCNotes from the Field: Trichophyton mentagrophytes Genotype VIICDCRecognition of Antifungal-Resistant Dermatophytosis by Infectious ...

Use a topical antifungal cream for mild, non-extensive tinea cruris in adults or children. Allylamines, including terbinafine, butenafine, and naftifine, and azoles, including clotrimazole, miconazole, econazole, ketoconazole, oxiconazole, and sulconazole, are standard topical options; topical regimens are generally used once or twice daily for 2–4 weeks. PubMed+1PubMedTinea Cruris - StatPearls - NCBI Bookshelfcks nice org ukScenario: Management | Management | Fungal skin infection - body and groin | CKS | NICE

Choose an agent according to formulary access, expected adherence, prior exposure, and labeled indication. Evidence from randomized trials supports topical terbinafine versus placebo for clinical cure in tinea corporis/cruris, and systematic-review evidence supports multiple topical antifungals, particularly azoles, for clinical and mycologic cure. Wiley+1WileyEvidence‐based topical treatments for tinea cruris and tinea corporis: a summary of a Cochrane systematic review - Zuuren - 2015 - British Journal of Dermatology - Wiley Online LibraryCochraneTopical antifungal treatments for tinea cruris and tinea corporis - El‐Gohary, M - 2014 | Cochrane Library

Do not add a topical corticosteroid routinely. Combination steroid-antifungal therapy may reduce visible inflammation transiently, but available evidence found similar mycologic cure compared with antifungal alone and is of very low quality; CDC specifically advises avoiding corticosteroid products, including combination products, because they can worsen dermatophyte infection. Cochrane+1CochraneTopical antifungal treatments for tinea cruris and tinea corporis - El‐Gohary, M - 2014 | Cochrane LibraryCDCNotes from the Field: Trichophyton mentagrophytes Genotype VII

Examine toe webs, plantar surfaces, and toenails at the initial visit and at apparent treatment failure. Tinea pedis and onychomycosis commonly coexist with dermatophyte skin disease, and untreated nail infection can prevent complete clearance of tinea cruris through reinfection. ScienceDirect+1ScienceDirectTinea cruris - an overview | ScienceDirect TopicsCDCClinical Overview of Ringworm | Ringworm | CDC

For weeping or macerated groin lesions, use Burow solution compresses to dry the area before topical antifungal application. Avoid mixing nystatin powder directly with antifungal cream because the combination can form a gritty, irritating mixture; nystatin is relevant to Candida, not dermatophyte-directed therapy. ScienceDirectScienceDirectTinea cruris - an overview | ScienceDirect Topics

When TMVII is suspected or confirmed, counsel patients to avoid direct skin-to-skin contact with affected areas and not share personal items until symptoms resolve. This organism can be sexually transmitted and may favor anogenital skin. CDCCDCNotes from the Field: Trichophyton mentagrophytes Genotype VII

Consider oral antifungal therapy when tinea cruris is resistant to topical treatment, when topical agents cannot be used, or when disease extent makes topical treatment impractical. Guidelines strongly recommend oral therapy for tinea corporis/cruris in patients unable to use or resistant to topical agents, while emphasizing that limited disease is generally managed topically. WileyWileyGuidelines for the management of dermatomycosis (2019)

Before systemic escalation in refractory disease, obtain fungal culture and request species identification and antifungal susceptibility testing when available. T. indotineae can cause extensive plaques involving the trunk, extremities, groin, and face and often does not resolve with over-the-counter topical therapy or oral terbinafine. CDCCDCRecognition of Antifungal-Resistant Dermatophytosis by Infectious ...

Itraconazole has been used successfully for T. indotineae and terbinafine-resistant T. rubrum, but resistant-disease management is not standardized in U.S. national guidelines. If itraconazole is selected, account for variable absorption, drug-drug interactions, insurance barriers, potentially prolonged treatment exceeding 6 weeks, and emerging itraconazole resistance; obtain specialist input when susceptibility testing, regimen selection, or drug-interaction management is needed. CDCCDCRecognition of Antifungal-Resistant Dermatophytosis by Infectious ...