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Tinea Cruris Clinical Presentation

  • Author: Michael Wiederkehr, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Nov 18, 2015
 

History

Patients with tinea cruris report pruritus and rash in the groin. A history of previous episodes of a similar problem usually is elicited. Additional historical information in patients with tinea cruris may include recently visiting a tropical climate, wearing tight-fitting clothes (including bathing suits) for extended periods, sharing clothing with others, participating in sports, or coexisting diabetes mellitus or obesity. Prison inmates, members of the armed forces, members of athletic teams, and people who wear tight clothing may be subject to independent or additional risk for dermatophytosis.

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Physical

Tinea cruris manifests as a symmetric erythematous rash in the groin, as shown in the images below.

Tinea cruris. Tinea cruris.
Tinea cruris. Tinea cruris.
Tinea cruris. Tinea cruris.

Large patches of erythema with central clearing are centered on the inguinal creases and extend distally down the medial aspects of the thighs and proximally to the lower abdomen and pubic area.

Scale is demarcated sharply at the periphery.

In acute tinea cruris infections, the rash may be moist and exudative.

Chronic infections typically are dry with a papular annular or arciform border and barely perceptible scale at the margin.

Central areas typically are hyperpigmented and contain a scattering of erythematous papules and a little scale.

The penis and scrotum typically are spared in tinea cruris; however, the infection may extend to the perineum and buttocks.

Secondary changes of excoriation, lichenification, and impetiginization may be present as a result of pruritus.

Chronic infections modified by the application of topical corticosteroids are more erythematous, less scaly, and may have follicular pustules.

Approximately one half of patients with tinea cruris have coexisting tinea pedis.

Erythematous-scale plaques and erythematous-liquenificated plaques were the most frequently found clinical types in an excellent Brazilian study.[5] T rubrum was the prevalent dermatophyte in 90% of the cases, followed by T tonsurans (6%) and T mentagrophytes (4%).

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Causes

The dermatophyte T rubrum is the most common etiologic agent for tinea cruris.[6] In a Brazilian series, T rubrum was the prevalent dermatophyte in 90% of the tinea cruris cases, followed by T tonsurans (6%) and T mentagrophytes (4%).[5] Other organisms, including E floccosum and T verrucosum, cause an identical clinical condition. T rubrum and E floccosum infections are more apt to become chronic and noninflammatory, while infection by T mentagrophytes often is associated with an acute inflammatory clinical presentation.

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Contributor Information and Disclosures
Author

Michael Wiederkehr, MD Consulting Staff, Livingston Dermatology Associates; Consulting Staff, Comprehensive Dermatology and Laser Center

Michael Wiederkehr, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Lester F Libow, MD Dermatopathologist, South Texas Dermatopathology Laboratory

Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Texas Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Gregory J Raugi, MD, PhD Professor, Department of Internal Medicine, Division of Dermatology, University of Washington at Seattle School of Medicine; Chief, Dermatology Section, Primary and Specialty Care Service, Veterans Administration Medical Center of Seattle

Gregory J Raugi, MD, PhD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References
  1. Foster KW, Ghannoum MA, Elewski BE. Epidemiologic surveillance of cutaneous fungal infection in the United States from 1999 to 2002. J Am Acad Dermatol. 2004 May. 50(5):748-52. [Medline].

  2. Sadri MF, Farnaghi F, Danesh-Pazhooh M, Shokoohi A. The frequency of tinea pedis in patients with tinea cruris in Tehran, Iran. Mycoses. 2000. 43(1-2):41-4. [Medline].

  3. Yehia MA, El-Ammawi TS, Al-Mazidi KM, Abu El-Ela MA, Al-Ajmi HS. The Spectrum of Fungal Infections with a Special Reference to Dermatophytoses in the Capital Area of Kuwait During 2000-2005: A Retrospective Analysis. Mycopathologia. 2009 Nov 17. [Medline].

  4. Patel GA, Wiederkehr M, Schwartz RA. Tinea cruris in children. Cutis. 2009 Sep. 84(3):133-7. [Medline].

  5. Silva-Tavares H, Alchorne MM, Fischman O. Tinea cruris epidemiology (São Paulo, Brazil). Mycopathologia. 2001. 149(3):147-9. [Medline].

  6. Koksal F, Er E, Samasti M. Causative agents of superficial mycoses in Istanbul, Turkey: retrospective study. Mycopathologia. 2009 Sep. 168(3):117-23. [Medline].

  7. Torok L, Tiszlavicz L, Somogyi T, Toth G, Tapai M. Perianal ulcer as a leading symptom of paediatric Langerhans' cell histiocytosis. Acta Derm Venereol. 2000 Jan-Feb. 80(1):49-51. [Medline].

  8. Chang CH, Young-Xu Y, Kurth T, Orav JE, Chan AK. The safety of oral antifungal treatments for superficial dermatophytosis and onychomycosis: a meta-analysis. Am J Med. 2007 Sep. 120(9):791-8. [Medline].

  9. Parish LC, Parish JL, Routh HB, Avakian E, Olayinka B, Pappert EJ, et al. A double-blind, randomized, vehicle-controlled study evaluating the efficacy and safety of naftifine 2% cream in tinea cruris. J Drugs Dermatol. 2011 Oct 1. 10(10):1142-7. [Medline].

  10. Choudhary S, Bisati S, Singh A, Koley S. Efficacy and Safety of Terbinafine Hydrochloride 1% Cream vs. Sertaconazole Nitrate 2% Cream in Tinea Corporis and Tinea Cruris: A Comparative Therapeutic Trial. Indian J Dermatol. 2013 Nov. 58(6):457-60. [Medline]. [Full Text].

  11. Plaum S, Verma A, Fleischer AB Jr, Olayinka B, Hardas B. Detection and relevance of naftifine hydrochloride in the stratum corneum up to four weeks following the last application of naftifine cream and gel, 2%. J Drugs Dermatol. 2013 Sep. 12(9):1004-8. [Medline].

  12. Bakos L, Brito AC, Castro LC, et al. Open clinical study of the efficacy and safety of terbinafine cream 1% in children with tinea corporis and tinea cruris. Pediatr Infect Dis J. 1997 Jun. 16(6):545-8. [Medline].

  13. Bonifaz A, Saul A. Comparative study between terbinafine 1% emulsion-gel versus ketoconazole 2% cream in tinea cruris and tinea corporis. Eur J Dermatol. 2000 Mar. 10(2):107-9. [Medline].

  14. Chen S, Ran Y, Dai Y, Lama J, Hu W, Zhang C. Administration of Oral Itraconazole Capsule with Whole Milk Shows Enhanced Efficacy As Supported by Scanning Electron Microscopy in a Child with Tinea Capitis Due to Microsporum canis. Pediatr Dermatol. 2015 Oct 8. [Medline].

 
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Tinea cruris.
Tinea cruris.
Tinea cruris.
Tinea cruris (hematoxylin and eosin stain).
Tinea cruris (periodic acid-Schiff stain, magnification X 20).
Tinea cruris (Gomori methenamine-silver stain, magnification X 20).
 
 
 
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