eMedicine Specialties > Dermatology > Fungal Infections

Tinea Cruris

Author: Michael Wiederkehr, MD, Consulting Staff, Livingston Dermatology Associates; Consulting Staff, Comprehensive Dermatology and Laser Center
Coauthor(s): Robert A Schwartz, MD, MPH, Professor and Head of Dermatology, Professor of Medicine, Professor of Pediatrics, Professor of Pathology, Professor of Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Contributor Information and Disclosures

Updated: May 20, 2008

Introduction

Background

Tinea cruris, a pruritic superficial fungal infection of the groin and adjacent skin, is the second most common clinical presentation for dermatophytosis. Tinea cruris is a common and important clinical problem that may, at times, be a diagnostic and therapeutic challenge.

The following other eMedicine articles on tinea infections may be of interest:

Additionally, the Medscape CME course Fungal Skin and Nail Infections: Practical Advice for Advanced Practice Clinicians may be of interest.

Pathophysiology

The most common etiologic agents for tinea cruris include Trichophyton rubrum and Epidermophyton floccosum; less commonly Trichophyton mentagrophytes and Trichophyton verrucosum are involved. Tinea cruris is a contagious infection transmitted by fomites, such as contaminated towels or hotel bedroom sheets, or by autoinoculation from a reservoir on the hands or feet (tinea manuum, tinea pedis, tinea unguium). The etiologic agents produce keratinases, which allow invasion of the cornified cell layer of the epidermis. The host immune response may prevent deeper invasion. Risk factors for initial infection or reinfection include wearing tight-fitting or wet clothing or undergarments.

Frequency

United States

Dermatophytosis accounts for approximately 10-20% of all visits to dermatologists.

International

Tinea cruris has a worldwide distribution but is found more commonly in hot humid climates.

Mortality/Morbidity

No mortality is associated with tinea cruris. Associated pruritus leads to morbidity resulting from lichenification, secondary bacterial infection, and irritant and allergic contact dermatitis caused by topically applied medications.

Sex

Tinea cruris is 3 times more common in men than in women.

Age

Adults are affected much more commonly than are children.

Clinical

History

Patients complain of pruritus and rash in the groin. A history of previous episodes of a similar problem usually is elicited. Additional historical information 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.

Physical

Tinea cruris manifests as a symmetric erythematous rash in the groin.

  • 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 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; 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.1 T rubrum was the prevalent dermatophyte in 90% of the cases, followed by T tonsurans (6%) and T mentagrophytes (4%).

Causes

The dermatophyte T rubrum is the most common etiologic agent for tinea cruris. In a Brazilian series, T rubrum was the prevalent dermatophyte in 90% of the cases, followed by T tonsurans (6%) and T mentagrophytes (4%).1 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.

More on Tinea Cruris

Overview: Tinea Cruris
Differential Diagnoses & Workup: Tinea Cruris
Treatment & Medication: Tinea Cruris
Follow-up: Tinea Cruris
Multimedia: Tinea Cruris
References
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References

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Further Reading

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Keywords

tinea inguinalis, groin dermatophytosis, ringworm of the groin, gym itch, eczema marginatum, dhobie itch, jock itch, crotch rot, Trichophyton rubrum, T rubrum, Epidermophyton floccosum, E floccosum, Trichophyton mentagrophytes, T mentagrophytes, Trichophyton verrucosum, T verrucosum

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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 and American Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Robert A Schwartz, MD, MPH, Professor and Head of Dermatology, Professor of Medicine, Professor of Pediatrics, Professor of Pathology, Professor of Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

Medical Editor

Gregory J Raugi, MD, PhD, Professor, Department of Internal Medicine, Division of Dermatology, University of Washington at Seattle; 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.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University 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, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

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, and Texas Medical Association
Disclosure: Nothing to disclose.

CME Editor

Glen H Crawford, MD, Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital
Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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