{
  "schemaVersion": 2,
  "eyebrow": "Dermatology",
  "title": "Tinea Cruris",
  "summary": "Confirm dermatophyte infection when morphology is atypical, recurrent, extensive, or treatment-refractory; treat limited disease with topical antifungal monotherapy, identify pedal or nail reservoirs, and escalate persistent disease to culture, speciation, susceptibility testing, and systemic therapy planning.",
  "seoDescription": "Physician guide to diagnosing and managing tinea cruris, including KOH testing, differential diagnosis, topical treatment, recurrence, and resistant dermatophytes.",
  "clinicalQuestion": "How should clinicians confirm, treat, and escalate suspected tinea cruris that is extensive, recurrent, or unresponsive to topical therapy?",
  "specialty": "Dermatology",
  "audience": "U.S. physicians and medical trainees",
  "tags": [
    "tinea cruris",
    "jock itch",
    "dermatophyte infection",
    "KOH preparation",
    "tinea incognito",
    "Trichophyton indotineae",
    "antifungal resistance"
  ],
  "keyTakeaways": [
    "Obtain a KOH preparation from the active advancing border when the diagnosis is uncertain, disease is recurrent or extensive, or empiric treatment has failed; hyphae support dermatophyte infection. [9][22]",
    "For mild, non-extensive tinea cruris, use topical antifungal monotherapy; allylamines and azoles are standard options, generally applied once or twice daily for 2–4 weeks. [18][19]",
    "Avoid topical corticosteroids, including antifungal-corticosteroid combinations, in suspected dermatophyte infection because they can worsen or mask tinea and complicate recognition of resistant disease. [20][21]",
    "Examine and address concurrent tinea pedis and onychomycosis, which can maintain reinoculation and prevent durable clearance of groin disease. [9][22]",
    "For persistent or severe disease, obtain fungal culture with dermatophyte identification and antifungal susceptibility testing when available; resistant T. indotineae may not respond to topical agents or oral terbinafine. [21]"
  ],
  "sections": [
    {
      "id": "confirm-the-diagnosis",
      "eyebrow": "Initial evaluation",
      "heading": "Confirm dermatophyte infection before escalating treatment",
      "intro": "Testing is most valuable when morphology, response, or epidemiology makes a clinical diagnosis unreliable.",
      "paragraphs": [
        "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. [9][22]",
        "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. [10][11]",
        "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. [21]"
      ],
      "bullets": [
        "Ask specifically about topical corticosteroid exposure, including combination products; altered morphology should prompt KOH and culture rather than escalation of steroid treatment. [20][21]",
        "Assess for extensive plaques involving trunk, face, extremities, groin, or anogenital skin; this distribution raises concern for emerging dermatophytes when disease is unusually inflammatory or treatment-refractory. [20][21]",
        "Ask about close skin-to-skin contact, affected contacts, travel or immigration involving South Asia, and animal exposure when culture is being pursued; these exposures can alter concern for T. indotineae or sexually associated Trichophyton mentagrophytes genotype VII (TMVII). [20][21]"
      ],
      "subsections": [],
      "table": {
        "caption": "Tests and bedside discriminators for a groin eruption suspected to be tinea cruris. [9][20][21]",
        "columns": [
          "Finding or test",
          "Interpretation",
          "Next action"
        ],
        "rows": [
          [
            "KOH scraping from advancing border shows hyphae",
            "Supports dermatophyte infection. [9]",
            "Treat as tinea cruris; evaluate feet and nails for a reservoir. [9][22]"
          ],
          [
            "KOH negative but active scaly border persists or prior therapy confounds sampling",
            "False-negative microscopy remains possible because sampling and test performance are imperfect. [10][11]",
            "Repeat scraping from an active edge and obtain fungal culture if treatment escalation is contemplated. [10][21]"
          ],
          [
            "Coral-colored fluorescence under ultraviolet light",
            "Favors erythrasma over dermatophyte infection. [9]",
            "Redirect treatment away from dermatophyte-focused therapy. [9]"
          ],
          [
            "Extensive, persistent disease despite topical therapy or oral terbinafine",
            "Raises concern for resistant dermatophytosis, including T. indotineae. [21]",
            "Obtain culture, species identification, and antifungal susceptibility testing when available; plan systemic therapy with attention to itraconazole limitations. [21]"
          ]
        ]
      }
    },
    {
      "id": "separate-common-mimics",
      "eyebrow": "Differential diagnosis",
      "heading": "Use distribution and targeted tests to separate common mimics",
      "intro": "A groin eruption that is not dermatophyte infection should not receive prolonged antifungal escalation.",
      "paragraphs": [
        "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. [8][9]",
        "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. [9]",
        "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. [20][21]"
      ],
      "bullets": [
        "Do not equate symptomatic improvement during a topical corticosteroid course with fungal eradication; corticosteroid-containing combinations have not shown superior mycologic cure over antifungal treatment alone in low-quality evidence. [17]",
        "If a presumed dermatophyte eruption involves genital or anogenital skin and there is potential sexual transmission, consider TMVII and advise avoiding skin-to-skin contact with affected areas and avoiding shared personal items until symptoms resolve. [20]"
      ],
      "subsections": [],
      "table": {
        "caption": "High-yield alternatives to tinea cruris and the discriminator that changes management. [8][9][20]",
        "columns": [
          "Alternative diagnosis",
          "Discriminator",
          "Management implication"
        ],
        "rows": [
          [
            "Erythrasma",
            "Coral-colored fluorescence with ultraviolet light. [9]",
            "Do not continue empiric dermatophyte escalation without reassessing the diagnosis. [9]"
          ],
          [
            "Candidal intertrigo",
            "Chronic moist-fold disease, especially in obesity; may coexist with tinea. [9]",
            "Address candidal involvement and fold moisture rather than attributing persistence solely to dermatophyte resistance. [9]"
          ],
          [
            "Irritant or allergic contact dermatitis",
            "Compatible morphology with negative mycology or exposure-related distribution. [8][9]",
            "Remove the offending exposure and avoid unnecessary prolonged antifungal treatment. [8][9]"
          ],
          [
            "Psoriasis or seborrheic dermatitis",
            "Persistent intertriginous eruption without demonstrated hyphae. [8][9]",
            "Reassess diagnosis before systemic antifungal therapy. [8][9]"
          ],
          [
            "Steroid-modified tinea",
            "Current or recent topical corticosteroid or combination-product use with atypical eruption. [20][21]",
            "Stop steroid-containing therapy, obtain KOH/culture when possible, and use antifungal-directed treatment. [20][21]"
          ]
        ]
      }
    },
    {
      "id": "treat-localized-disease",
      "eyebrow": "First-line treatment",
      "heading": "Treat limited disease with topical antifungal monotherapy",
      "intro": "Topical treatment is preferred when disease is mild and non-extensive.",
      "paragraphs": [
        "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. [18][19]",
        "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. [15][17]",
        "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. [17][20]"
      ],
      "bullets": [
        "Naftifine 2% cream has FDA approval for tinea cruris caused by Trichophyton rubrum in adults; use according to the current product label. [2]",
        "Luliconazole 1% cream is FDA-approved for tinea cruris caused by T. rubrum or Epidermophyton floccosum in patients aged 18 years or older; use according to the current product label. [3]",
        "Reassess a patient with ongoing active scale, expanding border, or new sites after an adequate adherent topical course; obtain mycologic testing instead of repeatedly substituting empiric topical products. [21][22]"
      ],
      "subsections": [],
      "table": {
        "caption": "Topical treatment selection for uncomplicated tinea cruris. [2][3][15][18][19]",
        "columns": [
          "Clinical situation",
          "Preferred approach",
          "Important limitation"
        ],
        "rows": [
          [
            "Mild, non-extensive disease",
            "Topical antifungal monotherapy; allylamine or azole regimens are generally used once or twice daily for 2–4 weeks. [18][19]",
            "Persistent active disease requires diagnostic reassessment, not indefinite empiric topical therapy. [21]"
          ],
          [
            "Adult with susceptible labeled organisms and access to naftifine",
            "Naftifine 2% cream is FDA-approved for adult tinea cruris caused by T. rubrum. [2]",
            "Use only within current labeling and reassess nonresponse. [2][21]"
          ],
          [
            "Adult with susceptible labeled organisms and access to luliconazole",
            "Luliconazole 1% cream is FDA-approved for adult tinea cruris caused by T. rubrum or E. floccosum. [3]",
            "Label indication is limited to patients aged 18 years and older. [3]"
          ],
          [
            "Marked inflammation after prior steroid exposure",
            "Stop steroid-containing product and confirm dermatophyte infection with KOH/culture when feasible. [20][21]",
            "Combination products can mask progression and worsen tinea. [20]"
          ]
        ]
      }
    },
    {
      "id": "prevent-reinfection-and-recurrence",
      "eyebrow": "Reservoir control",
      "heading": "Find pedal, nail, contact, and moisture drivers of recurrence",
      "intro": "Persistent groin disease may represent reinoculation rather than drug failure.",
      "paragraphs": [
        "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. [9][22]",
        "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. [9]",
        "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. [20]"
      ],
      "bullets": [
        "In recurrent disease, treat demonstrable tinea pedis and evaluate suspected onychomycosis rather than treating the groin as an isolated site. [9][22]",
        "If close contacts have compatible eruptions, assess them clinically because direct person-to-person spread contributes to dermatophyte transmission. [22]",
        "Do not use topical corticosteroid products to suppress recurrent itch while awaiting reassessment; this can worsen or obscure dermatophyte infection. [20]"
      ],
      "subsections": [],
      "table": {
        "caption": "Actions that reduce persistence or reinoculation in tinea cruris. [9][20][22]",
        "columns": [
          "Potential driver",
          "What to assess",
          "Action"
        ],
        "rows": [
          [
            "Tinea pedis",
            "Interdigital and plantar scale or maceration. [22]",
            "Treat concurrent foot infection to reduce autoinoculation. [9][22]"
          ],
          [
            "Onychomycosis",
            "Thickened, discolored, brittle toenails. [22][24]",
            "Evaluate and treat confirmed nail disease when it is sustaining recurrent dermatophyte infection. [9]"
          ],
          [
            "Moist, weeping folds",
            "Maceration or exudation. [9]",
            "Use Burow solution compresses for drying before topical antifungal application. [9]"
          ],
          [
            "Potential sexual or household spread",
            "Affected close contacts, skin-to-skin exposure, or shared personal items. [20][22]",
            "Avoid skin-to-skin contact with affected lesions and avoid sharing personal items until symptom resolution. [20]"
          ]
        ]
      }
    },
    {
      "id": "manage-extensive-or-resistant-disease",
      "eyebrow": "Escalation",
      "heading": "Escalate extensive, refractory, or suspected resistant tinea with mycology",
      "intro": "Systemic treatment decisions should follow confirmation and resistance-oriented testing whenever possible.",
      "paragraphs": [
        "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. [13]",
        "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. [21]",
        "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. [21]"
      ],
      "bullets": [
        "Do not diagnose terbinafine resistance from persistent rash alone: verify ongoing dermatophyte infection and exclude dermatitis, erythrasma, candidal intertrigo, nonadherence, and an untreated foot or nail reservoir. [9][21]",
        "Consider T. indotineae particularly with refractory, extensive disease and travel or immigration linkage to South Asia. [20][21]",
        "Consider TMVII with anogenital-predominant tinea and potential sexual transmission; unlike T. indotineae, TMVII is described as generally susceptible to terbinafine first-line therapy. [20]"
      ],
      "subsections": [
        {
          "heading": "When to refer",
          "paragraphs": [
            "Refer to dermatology or infectious diseases for culture-confirmed or strongly suspected resistant dermatophytosis, disease requiring prolonged systemic therapy, inability to access species identification or susceptibility testing, or unresolved diagnostic uncertainty after KOH and culture. These scenarios require interpretation of species-level results, systemic-drug interaction review, and treatment adjustment when terbinafine or itraconazole failure occurs. [21]"
          ],
          "bullets": []
        }
      ],
      "table": {
        "caption": "Escalation pathway for tinea cruris not controlled with topical therapy. [13][20][21]",
        "columns": [
          "Escalation trigger",
          "Required evaluation",
          "Management direction"
        ],
        "rows": [
          [
            "Topical treatment failure",
            "Repeat KOH from active border; examine feet and nails; obtain fungal culture when systemic treatment is under consideration. [9][21]",
            "Use oral antifungal therapy when topical resistance or inability to use topical treatment is established. [13]"
          ],
          [
            "Extensive or unusually inflammatory plaques",
            "Culture with species identification and susceptibility testing when available. [21]",
            "Evaluate for T. indotineae and avoid assuming oral terbinafine will be effective. [21]"
          ],
          [
            "Suspected terbinafine-resistant dermatophyte",
            "Confirm organism and susceptibility profile when possible. [21]",
            "Itraconazole has been used successfully, but manage absorption, interactions, prolonged-course needs, and emerging resistance. [21]"
          ],
          [
            "Anogenital disease with possible sexual spread",
            "Obtain mycology and consider TMVII. [20]",
            "Counsel against skin-to-skin contact with affected sites and sharing personal items until symptoms resolve. [20]"
          ]
        ]
      }
    }
  ],
  "faq": [],
  "references": [
    {
      "number": 1,
      "title": "[PDF] Application Type Efficacy Supplement - FDA",
      "detail": "www.fda.gov",
      "url": "https://www.fda.gov/media/111545/download",
      "authors": "www.fda.gov",
      "host": "www.fda.gov"
    },
    {
      "number": 2,
      "title": "[PDF] Clinical Review - FDA",
      "detail": "www.fda.gov",
      "url": "https://www.fda.gov/media/102199/download",
      "authors": "www.fda.gov",
      "host": "www.fda.gov"
    },
    {
      "number": 3,
      "title": "[PDF] Cross Discipline Team Leader Review - FDA",
      "detail": "www.fda.gov",
      "url": "https://www.fda.gov/media/111550/download",
      "authors": "www.fda.gov",
      "host": "www.fda.gov"
    },
    {
      "number": 4,
      "title": "Dermatophyte infections - Symptoms, diagnosis and treatment",
      "detail": "bestpractice.bmj.com",
      "url": "https://bestpractice.bmj.com/topics/en-us/119",
      "authors": "bestpractice.bmj.com",
      "host": "bestpractice.bmj.com"
    },
    {
      "number": 5,
      "title": "Re: Steroid modified tinea | The BMJ",
      "detail": "www.bmj.com",
      "url": "https://www.bmj.com/content/356/bmj.j973/rr",
      "authors": "www.bmj.com",
      "host": "www.bmj.com"
    },
    {
      "number": 6,
      "title": "Efficacy of Topical Antifungals in the Treatment of Dermatophytosis ...",
      "detail": "jamanetwork.com",
      "url": "https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=DERM&pdfFileName=dpz120011_341_349.pdf",
      "authors": "jamanetwork.com",
      "host": "jamanetwork.com"
    },
    {
      "number": 7,
      "title": "Management of tinea corporis, tinea cruris, and... : Indian Dermatology Online Journal",
      "detail": "journals.lww.com",
      "url": "https://journals.lww.com/idoj/fulltext/2016/07020/management_of_tinea_corporis,_tinea_cruris,_and.2.aspx",
      "authors": "journals.lww.com",
      "host": "journals.lww.com"
    },
    {
      "number": 8,
      "title": "Tinea Cruis: A Bothersome Male Condition - ScienceDirect",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/science/article/pii/S1555415505003235",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com"
    },
    {
      "number": 9,
      "title": "Tinea cruris - an overview | ScienceDirect Topics",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/topics/medicine-and-dentistry/tinea-cruris",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com"
    },
    {
      "number": 10,
      "title": "The 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 Library",
      "detail": "onlinelibrary.wiley.com",
      "url": "https://onlinelibrary.wiley.com/doi/10.1155/2010/764843",
      "authors": "onlinelibrary.wiley.com",
      "host": "onlinelibrary.wiley.com"
    },
    {
      "number": 11,
      "title": "Frequency of Culture-Proven Dermatophyte Infection in Patients with Suspected Tinea Pedis - ScienceDirect",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/science/article/abs/pii/S0002962915341264",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com"
    },
    {
      "number": 12,
      "title": "The Necessity of Culture for the Diagnosis of Tinea Pedis - ScienceDirect",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/science/article/abs/pii/S0002962915328470",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com"
    },
    {
      "number": 13,
      "title": "Guidelines for the management of dermatomycosis (2019)",
      "detail": "onlinelibrary.wiley.com",
      "url": "https://onlinelibrary.wiley.com/doi/10.1111/1346-8138.15618",
      "authors": "onlinelibrary.wiley.com",
      "host": "onlinelibrary.wiley.com"
    },
    {
      "number": 14,
      "title": "NEXTODERM: Consensus on Dermatophytosis Diagnosis and ...",
      "detail": "onlinelibrary.wiley.com",
      "url": "https://onlinelibrary.wiley.com/doi/10.1155/drp/1347872",
      "authors": "onlinelibrary.wiley.com",
      "host": "onlinelibrary.wiley.com"
    },
    {
      "number": 15,
      "title": "Evidence‐based topical treatments for tinea cruris and tinea corporis: a summary of a Cochrane systematic review - Zuuren - 2015 - British Journal of Dermatology - Wiley Online Library",
      "detail": "onlinelibrary.wiley.com",
      "url": "https://onlinelibrary.wiley.com/doi/abs/10.1111/bjd.13441",
      "authors": "onlinelibrary.wiley.com",
      "host": "onlinelibrary.wiley.com"
    },
    {
      "number": 16,
      "title": "Topical and oral treatments for fungal skin infections",
      "detail": "wchh.onlinelibrary.wiley.com",
      "url": "https://wchh.onlinelibrary.wiley.com/doi/pdf/10.1002/psb.360",
      "authors": "wchh.onlinelibrary.wiley.com",
      "host": "wchh.onlinelibrary.wiley.com"
    },
    {
      "number": 17,
      "title": "Topical antifungal treatments for tinea cruris and tinea corporis - El‐Gohary, M - 2014 | Cochrane Library",
      "detail": "www.cochranelibrary.com",
      "url": "https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009992.pub2/full",
      "authors": "www.cochranelibrary.com",
      "host": "www.cochranelibrary.com"
    },
    {
      "number": 18,
      "title": "Tinea Cruris - StatPearls - NCBI Bookshelf",
      "detail": "www.ncbi.nlm.nih.gov",
      "url": "https://www.ncbi.nlm.nih.gov/sites/books/NBK554602",
      "authors": "www.ncbi.nlm.nih.gov",
      "host": "www.ncbi.nlm.nih.gov"
    },
    {
      "number": 19,
      "title": "Scenario: Management | Management | Fungal skin infection - body and groin | CKS | NICE",
      "detail": "cks.nice.org.uk",
      "url": "https://cks.nice.org.uk/topics/fungal-skin-infection-body-groin/management/management",
      "authors": "cks.nice.org.uk",
      "host": "cks.nice.org.uk"
    },
    {
      "number": 20,
      "title": "Notes from the Field: Trichophyton mentagrophytes Genotype VII",
      "detail": "www.cdc.gov",
      "url": "https://www.cdc.gov/mmwr/volumes/73/wr/mm7343a5.htm",
      "authors": "www.cdc.gov",
      "host": "www.cdc.gov"
    },
    {
      "number": 21,
      "title": "Recognition of Antifungal-Resistant Dermatophytosis by Infectious ...",
      "detail": "wwwnc.cdc.gov",
      "url": "https://wwwnc.cdc.gov/eid/article/30/9/24-0118_article",
      "authors": "wwwnc.cdc.gov",
      "host": "wwwnc.cdc.gov"
    },
    {
      "number": 22,
      "title": "Clinical Overview of Ringworm | Ringworm | CDC",
      "detail": "www.cdc.gov",
      "url": "https://www.cdc.gov/ringworm/hcp/clinical-overview/index.html",
      "authors": "www.cdc.gov",
      "host": "www.cdc.gov"
    },
    {
      "number": 23,
      "title": "Efficacy of topical antifungal drugs in different dermatomycoses: a systematic review with meta-analysis - Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews - NCBI Bookshelf",
      "detail": "www.ncbi.nlm.nih.gov",
      "url": "https://www.ncbi.nlm.nih.gov/books/NBK132708",
      "authors": "www.ncbi.nlm.nih.gov",
      "host": "www.ncbi.nlm.nih.gov"
    },
    {
      "number": 24,
      "title": "Ringworm Basics | Ringworm | CDC",
      "detail": "www.cdc.gov",
      "url": "https://www.cdc.gov/ringworm/about/index.html",
      "authors": "www.cdc.gov",
      "host": "www.cdc.gov"
    }
  ],
  "editorialNote": "Prepared from cited clinical literature using Astra's research workflow. Verify recommendations against current guidance and patient-specific factors.",
  "citations": [
    {
      "number": 1,
      "title": "[PDF] Application Type Efficacy Supplement - FDA",
      "detail": "www.fda.gov",
      "url": "https://www.fda.gov/media/111545/download",
      "authors": "www.fda.gov",
      "host": "www.fda.gov",
      "snippet": "2.2 Tables of Currently Available Treatments for Proposed Indications It is well accepted that common tinea infections are treated with topical agents, therapeutic success is limited because of poor compliance, poor awareness regarding the disease condition by the patient, and frequent recurrence. I",
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    {
      "number": 2,
      "title": "[PDF] Clinical Review - FDA",
      "detail": "www.fda.gov",
      "url": "https://www.fda.gov/media/102199/download",
      "authors": "www.fda.gov",
      "host": "www.fda.gov",
      "snippet": "as treatment failure (MVTF). (1) Complete Cure was defined as negative mycology results (dermatophyte culture and KOH) and absence of erythema, induration, and pruritus (scores of 0 on each), (2) Effective Treatment was defined as negative KOH, negative culture, and erythema, induration, and pruritu",
      "score": 0.50241756
    },
    {
      "number": 3,
      "title": "[PDF] Cross Discipline Team Leader Review - FDA",
      "detail": "www.fda.gov",
      "url": "https://www.fda.gov/media/111550/download",
      "authors": "www.fda.gov",
      "host": "www.fda.gov",
      "snippet": "A total of 3 AEs were reported in 3 subjects in the tinea pedis group and 1 AE was reported in 1 subject in the tinea cruris group. Treatment-emergent AEs were reported by 2 subjects in the tinea pedis group and 1 subject in the tinea cruris group. There were no serious adverse events reported. Ther",
      "score": 0.39922652
    },
    {
      "number": 4,
      "title": "Dermatophyte infections - Symptoms, diagnosis and treatment",
      "detail": "bestpractice.bmj.com",
      "url": "https://bestpractice.bmj.com/topics/en-us/119",
      "authors": "bestpractice.bmj.com",
      "host": "bestpractice.bmj.com",
      "snippet": "### References\n\n#### Key articles\n\nAmeen M, Lear JT, Madan V, et al. British Association of Dermatologists' guidelines for the management of onychomycosis 2014. Br J Dermatol. 2014 Nov;171(5):937-58.Full textAbstract\n\nFuller LC, Barton RC, Mohd Mustapa MF, et al. British Association of Dermatologist",
      "score": 0.42935818
    },
    {
      "number": 5,
      "title": "Re: Steroid modified tinea | The BMJ",
      "detail": "www.bmj.com",
      "url": "https://www.bmj.com/content/356/bmj.j973/rr",
      "authors": "www.bmj.com",
      "host": "www.bmj.com",
      "snippet": "NICE guidelines currently recommend adding a mild-moderate steroid to a topical antifungal, when the skin is particularly inflamed. A Cochrane review reported that “there was evidence, albeit rated as very low quality, that moderate to potent strength corticosteroids combined with azoles achieved a ",
      "score": 0.27963957
    },
    {
      "number": 6,
      "title": "Efficacy of Topical Antifungals in the Treatment of Dermatophytosis ...",
      "detail": "jamanetwork.com",
      "url": "https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=DERM&pdfFileName=dpz120011_341_349.pdf",
      "authors": "jamanetwork.com",
      "host": "jamanetwork.com",
      "snippet": "Treatment of tinea cruris with topical terbinafine. ... Tinea corporis/cruris: new treatment options. ... azole cream 1% in the treatment of tinea cruris and tinea",
      "score": 0.5677694
    },
    {
      "number": 7,
      "title": "Management of tinea corporis, tinea cruris, and... : Indian Dermatology Online Journal",
      "detail": "journals.lww.com",
      "url": "https://journals.lww.com/idoj/fulltext/2016/07020/management_of_tinea_corporis,_tinea_cruris,_and.2.aspx",
      "authors": "journals.lww.com",
      "host": "journals.lww.com",
      "snippet": "topical antifungals in limited disease, and oral therapy is usually reserved for more extensive cases. The last few years have seen a significant rise in the incidence of chronic dermatophyte infections of skin which have proven difficult to treat. However, due to the lack of updated national or int",
      "score": 0.6141863
    },
    {
      "number": 8,
      "title": "Tinea Cruis: A Bothersome Male Condition - ScienceDirect",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/science/article/pii/S1555415505003235",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "Title: Tinea Cruis: A Bothersome Male Condition - ScienceDirect\n## The Journal for Nurse Practitioners. The Journal for Nurse Practitioners. # Men's Health Tinea Cruis: A Bothersome Male Condition. https://doi.org/10.1016/j.nurpra.2005.12.017Get rights and content. Tinea cruris, commonly referred to",
      "score": 0.5194
    },
    {
      "number": 9,
      "title": "Tinea cruris - an overview | ScienceDirect Topics",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/topics/medicine-and-dentistry/tinea-cruris",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "Treatment consists of drying the weeping areas with Burow solution compresses and application of topical antifungal agents. For those with Candida superinfection, the addition of nystatin powder is helpful due to its anti-infective and drying properties. Nystatin powder should not be mixed with the ",
      "score": 0.4746074
    },
    {
      "number": 10,
      "title": "The 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 Library",
      "detail": "onlinelibrary.wiley.com",
      "url": "https://onlinelibrary.wiley.com/doi/10.1155/2010/764843",
      "authors": "onlinelibrary.wiley.com",
      "host": "onlinelibrary.wiley.com",
      "snippet": "# The Sensitivity and Specificity of Potassium Hydroxide Smear and Fungal Culture Relative to Clinical Assessment in the Evaluation of Tinea Pedis: A Pooled Analysis. There are relatively few studies published examining the sensitivity and specificity of potassium hydroxide (KOH) smear and fungal cu",
      "score": 0.72348577
    },
    {
      "number": 11,
      "title": "Frequency of Culture-Proven Dermatophyte Infection in Patients with Suspected Tinea Pedis - ScienceDirect",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/science/article/abs/pii/S0002962915341264",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "The results of this study show that a dermatophyte grew on cultures in only 36.6% of the cases with a clinical diagnosis of tinea pedis. This ratio is quite close to the 32% that was calculated by Fuchs and colleagues.5 Even though the majority of our cases were referred by a dermatologist, in line ",
      "score": 0.6793707
    },
    {
      "number": 12,
      "title": "The Necessity of Culture for the Diagnosis of Tinea Pedis - ScienceDirect",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/science/article/abs/pii/S0002962915328470",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "### J Am Acad Dermatol\n\n### Tinea pedis in European marathon runners\n\n### J Eur Acad Dermatol Venereol\n\n## Cited by (11)\n\n### Innovations and Advances in Wound Healing, Third Edition\n\n### Clinico-mycological study of dermatophytic infections and their sensitivity to antifungal drugs in a tertiary ca",
      "score": 0.5957048
    },
    {
      "number": 13,
      "title": "Guidelines for the management of dermatomycosis (2019)",
      "detail": "onlinelibrary.wiley.com",
      "url": "https://onlinelibrary.wiley.com/doi/10.1111/1346-8138.15618",
      "authors": "onlinelibrary.wiley.com",
      "host": "onlinelibrary.wiley.com",
      "snippet": "## CQ9: Is an oral antifungal agent recommended for tinea corporis/cruris treatment?\n\nGrade of recommendation: A.\n\nRecommendation statement: Oral antifungal agents are strongly recommended for tinea corporis/cruris in patients who cannot use topical agents or are resistant to topical treatment.\n\nExp",
      "score": 0.6641271
    },
    {
      "number": 14,
      "title": "NEXTODERM: Consensus on Dermatophytosis Diagnosis and ...",
      "detail": "onlinelibrary.wiley.com",
      "url": "https://onlinelibrary.wiley.com/doi/10.1155/drp/1347872",
      "authors": "onlinelibrary.wiley.com",
      "host": "onlinelibrary.wiley.com",
      "snippet": "The management of recalcitrant tinea cruris ... The ideal treatment duration of continuous oral itraconazole/terbinafine dose is 4–6 weeks",
      "score": 0.6241337
    },
    {
      "number": 15,
      "title": "Evidence‐based topical treatments for tinea cruris and tinea corporis: a summary of a Cochrane systematic review - Zuuren - 2015 - British Journal of Dermatology - Wiley Online Library",
      "detail": "onlinelibrary.wiley.com",
      "url": "https://onlinelibrary.wiley.com/doi/abs/10.1111/bjd.13441",
      "authors": "onlinelibrary.wiley.com",
      "host": "onlinelibrary.wiley.com",
      "snippet": "Tinea cruris and tinea corporis are common fungal infections. Most can be treated with a variety of topical antifungals. This review aimed to assess the evidence for the effectiveness and safety of topical treatments for tinea cruris and tinea corporis. Searches included the Cochrane Skin Group Spec",
      "score": 0.56719416
    },
    {
      "number": 16,
      "title": "Topical and oral treatments for fungal skin infections",
      "detail": "wchh.onlinelibrary.wiley.com",
      "url": "https://wchh.onlinelibrary.wiley.com/doi/pdf/10.1002/psb.360",
      "authors": "wchh.onlinelibrary.wiley.com",
      "host": "wchh.onlinelibrary.wiley.com",
      "snippet": "The principal side-effects of topical therapy are local irritation and allergic reactions. terbinafine (Lamisil) for moccasin tinea pedis and",
      "score": 0.4338141
    },
    {
      "number": 17,
      "title": "Topical antifungal treatments for tinea cruris and tinea corporis - El‐Gohary, M - 2014 | Cochrane Library",
      "detail": "www.cochranelibrary.com",
      "url": "https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009992.pub2/full",
      "authors": "www.cochranelibrary.com",
      "host": "www.cochranelibrary.com",
      "snippet": "Title: Topical antifungal treatments for tinea cruris and tinea corporis - El‐Gohary, M - 2014 | Cochrane Library\nA substantial number of the studies were more than 20 years old and of unclear or high risk of bias; there is however, some evidence that other topical antifungal treatments also provide",
      "score": 0.56517935
    },
    {
      "number": 18,
      "title": "Tinea Cruris - StatPearls - NCBI Bookshelf",
      "detail": "www.ncbi.nlm.nih.gov",
      "url": "https://www.ncbi.nlm.nih.gov/sites/books/NBK554602",
      "authors": "www.ncbi.nlm.nih.gov",
      "host": "www.ncbi.nlm.nih.gov",
      "snippet": "## Treatment / Management\n\nAntifungals utilized in treating dermatophytoses, including tinea cruris, target the synthesis of ergosterol, a vital component of fungal plasma membranes.(#article-30207.r4) Management strategies are similar worldwide; however, some countries have specific guidelines base",
      "score": 0.54535896
    },
    {
      "number": 19,
      "title": "Scenario: Management | Management | Fungal skin infection - body and groin | CKS | NICE",
      "detail": "cks.nice.org.uk",
      "url": "https://cks.nice.org.uk/topics/fungal-skin-infection-body-groin/management/management",
      "authors": "cks.nice.org.uk",
      "host": "cks.nice.org.uk",
      "snippet": "* **Advise treatment with a topical antifungal cream** if there is mild, non-extensive disease in children and adults. See the CKS topics on Fungal nail infection and Fungal skin infection - foot for more information. These recommendations are based on the UK Health Security Agency publications *Fun",
      "score": 0.48850358
    },
    {
      "number": 20,
      "title": "Notes from the Field: Trichophyton mentagrophytes Genotype VII",
      "detail": "www.cdc.gov",
      "url": "https://www.cdc.gov/mmwr/volumes/73/wr/mm7343a5.htm",
      "authors": "www.cdc.gov",
      "host": "www.cdc.gov",
      "snippet": "\\ These authors contributed equally to this report.\n\n† Typically, dermatophyte infections of the skin, also called tinea or ringworm, are mild conditions that can be treated with topical antifungals and do not affect the genitals. TMVII might have a predilection for anogenital skin. TMVII is distinc",
      "score": 0.3070052
    },
    {
      "number": 21,
      "title": "Recognition of Antifungal-Resistant Dermatophytosis by Infectious ...",
      "detail": "wwwnc.cdc.gov",
      "url": "https://wwwnc.cdc.gov/eid/article/30/9/24-0118_article",
      "authors": "wwwnc.cdc.gov",
      "host": "wwwnc.cdc.gov",
      "snippet": "Dermatophyte species identification and AFST are critical to guiding antifungal treatment decisions for patients with potentially resistant dermatophytosis and for monitoring population-level trends in resistance profiles to inform treatment guidelines (8). National guidelines for treating antifunga",
      "score": 0.30108505
    },
    {
      "number": 22,
      "title": "Clinical Overview of Ringworm | Ringworm | CDC",
      "detail": "www.cdc.gov",
      "url": "https://www.cdc.gov/ringworm/hcp/clinical-overview/index.html",
      "authors": "www.cdc.gov",
      "host": "www.cdc.gov",
      "snippet": "Two healthcare professionals talking\n\n## Overview\n\nRingworm, also called tinea, is a common skin infection caused by a group of fungi called dermatophytes. The infection often looks like a circular, scaly rash. Ringworm can appear on different parts of the body including the scalp, feet (athlete's f",
      "score": 0.24485515
    },
    {
      "number": 23,
      "title": "Efficacy of topical antifungal drugs in different dermatomycoses: a systematic review with meta-analysis - Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews - NCBI Bookshelf",
      "detail": "www.ncbi.nlm.nih.gov",
      "url": "https://www.ncbi.nlm.nih.gov/books/NBK132708",
      "authors": "www.ncbi.nlm.nih.gov",
      "host": "www.ncbi.nlm.nih.gov",
      "snippet": "METHODS: A systematic review of randomized clinical trials, published in Portuguese, Spanish and English until July 2010, which compared the use of azole and allylamine antifungal drugs among themselves and with placebo in the treatment of cutaneous candidiasis and T. versicolor, T. pedis, T. cruris",
      "score": 0.19845259
    },
    {
      "number": 24,
      "title": "Ringworm Basics | Ringworm | CDC",
      "detail": "www.cdc.gov",
      "url": "https://www.cdc.gov/ringworm/about/index.html",
      "authors": "www.cdc.gov",
      "host": "www.cdc.gov",
      "snippet": "### Skin and scalp infections\n\nSkin infections are more common on certain parts of the body like on the foot or groin. Ringworm on feet (tinea pedis) is often referred to as athlete's foot. Ringworm on the groin (tinea cruris) is often called jock itch. Tinea of the scalp, tinea capitis, is also com",
      "score": 0.163379
    }
  ],
  "publishedAt": "2026-09-15T23:53:14.307114+00:00",
  "updatedAt": "2026-09-15T23:53:14.307114+00:00",
  "readingMinutes": 6,
  "slug": "tinea-cruris"
}