eMedicine Specialties > Dermatology > Fungal Infections
Tinea Cruris: Treatment & Medication
Updated: Dec 2, 2009
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Treatment
Medical Care
Clinical cure of an uncomplicated tinea cruris infection usually can be achieved using topical antifungal agents of the imidazole or allylamine family. Consider patients unable to use topical treatments consistently or with extensive or recalcitrant infection as candidates for systemic administration of antifungal therapy, which has been proven safe in immunocompetent persons.8
Prevention of tinea cruris reinfection is an essential component of disease management. Patients with tinea cruris often have concurrent dermatophyte infections of the feet and hands.
- Treat all active areas of tinea cruris infection simultaneously to prevent reinfection of the groin from other body sites.
- Advise patients with tinea pedis to put on their socks before their undershorts to reduce the possibility of direct contamination.
- Advise patients with tinea cruris to dry the crural folds completely after bathing and to use separate towels for drying the groin and other parts of the body.
Diet
Recommend weight loss for patients who are obese and have tinea cruris.
Medication
To achieve the best results, particularly with follicular or extensive tinea cruris, the authors often recommend a combination of topical and systemic therapy.
Antifungal agents
The 2 classes of antifungal medications used most commonly to treat tinea cruris are the azoles and the allylamines. Azoles inhibit the enzyme lanosterol 14-alpha-demethylase, an enzyme that converts lanosterol to ergosterol, which is an important component of the fungal cell wall. Membrane damage results in permeability problems and renders the fungus unable to reproduce. Allylamines inhibit squalene epoxidase, which is an enzyme that converts squalene to ergosterol, resulting in the accumulation of toxic levels of squalene in the cell and in cell death. Examples of both classes of antifungal agents are available for topical and systemic administration.
Studies have found terbinafine to be effective and well tolerated in children.9 Terbinafine 1% emulsion gel was found to be more effective than ketoconazole 2% cream in the treatment of tinea cruris.10
Terbinafine (Lamisil)
Synthetic allylamine derivative, which inhibits squalene epoxidase, a key enzyme in sterol biosynthesis in fungi that results in a deficiency of ergosterol, causing fungal cell death. Widely studied and effective topical or oral antifungal. Topical form available without prescription. Some clinicians reserve this drug for more widespread/resistant infections because of its broad coverage and increased cost. Studies have found this medication to be effective and well tolerated in children.
Adult
Topical: Apply to affected area qd for 1-4 wk
Oral: 250 mg/d for 2 wk
Pediatric
Topical: Administer as in adults
Oral treatment based on body weight:
12-20 kg: 62.5 mg/d for 2 weeks
20-40 kg: 125 mg/d for 2 weeks
>40 kg: 250 mg/d for 2 weeks
When administered concurrently with cyclosporine, oral administration of terbinafine may increase cyclosporine clearance; conversely, rifampin may decrease terbinafine clearance; cimetidine may decrease terbinafine clearance
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Discontinue if symptoms or signs of hepatobiliary dysfunction or cholestatic hepatitis develop or if chemical irritation occurs; topical dosage form is for external use only; avoid contact with eyes
Butenafine (Mentax)
Potent antifungal related to the allylamines. Damages fungal cell membranes causing fungal cell growth to arrest.
Available in 1% cream only.
Adult
Apply topically to affected area qd for 2-4 wk
Pediatric
<12 years: Not established
>12 years: Administer as in adults
None reported
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Use topically (not in eyes, vagina, or other internal routes)
Clotrimazole (Lotrimin, Mycelex)
Often, first-line drug used in the treatment of tinea cruris. Broad-spectrum antifungal agent that inhibits yeast growth by altering cell membrane permeability, causing death of fungal cells. Reevaluate diagnosis if no clinical improvement after 4 wk.
Available without a prescription. 1% cream, solution/spray, and lotion available.
Adult
Gently massage into affected area and surrounding skin areas bid for 4 wk
Pediatric
Administer as in adults
None reported
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Not for treatment of systemic fungal infections; avoid contact with the eyes; if irritation or sensitivity develops, discontinue use and institute appropriate therapy
Miconazole (Micatin, Monistat-Derm)
Damages fungal cell wall membrane by inhibiting biosynthesis of ergosterol. Membrane permeability is increased causing nutrients to leak, resulting in fungal cell death.
Available without a prescription, and 2% cream, solution/spray, lotion, and powder forms available. Lotion is preferred in intertriginous areas. If cream is used, apply sparingly to avoid maceration effects.
Adult
Cream and lotion: Cover affected areas bid for 4 wk
Powder: Spray or sprinkle liberally over affected area bid for 4 wk
Pediatric
Administer as in adults
None reported
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Discontinue if sensitivity or chemical irritation occurs; for external use only; avoid contact with eyes
Ketoconazole (Nizoral)
2% cream. Imidazole broad-spectrum antifungal agent; inhibits synthesis of ergosterol, causing cellular components to leak, resulting in fungal cell death.
Adult
Rub gently into affected area qd or bid for 2-4 wk
Pediatric
Administer as in adults
None reported
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Discontinue if sensitivity or irritation develops; for external use only; avoid contact with eyes
Econazole (Spectazole)
Effective in cutaneous infections. Interferes with RNA and protein synthesis and metabolism. Disrupts fungal cell wall permeability, causing fungal cell death.
Adult
Apply sparingly over affected area qd/bid for 2-4 wk
Pediatric
Administer as in adults
None reported
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Discontinue if sensitivity or irritation develops; for external use only; avoid contact with eyes
Naftifine (Naftin)
Broad-spectrum antifungal agent and synthetic allylamine derivative; may decrease the synthesis of ergosterol, which in turn inhibits fungal cell growth
Available in 1% cream or solution.
If no clinical improvement after 4 wk, reevaluate patient.
Adult
Cream/gel: Gently massage sparingly into affected area and surrounding skin qd for 2-4 wk
Pediatric
Administer as in adults
None reported
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Discontinue use if sensitivity or chemical irritation occurs; for external use only; avoid contact with eyes
Oxiconazole (Oxistat)
Broad-spectrum antifungal agent. Inhibits synthesis of ergosterol, causing cellular components to leak, resulting in fungal cell death.
1% cream or lotion.
Adult
Apply topically to affected area qd for 2-4 wk
Pediatric
<12 years: Not established
>12 years: Administer as in adults
None reported
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
For external use only
Tolnaftate (Tinactin)
Nonprescription medication used in the treatment of tinea cruris. Available in 1% cream, solution/spray, and powder.
Adult
Apply topically bid
Pediatric
Administer as in adults
None reported
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
For external use only
Haloprogin (Halotex)
Agent for use in the treatment of tinea cruris. Prescription only. Available in 1% cream and solution/spray.
Adult
Apply topically tid
Pediatric
Administer as in adults
None reported
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
For external use only
Ciclopirox (Loprox)
Synthetic broad-spectrum antifungal agent. Interferes with synthesis of DNA, RNA, and protein by inhibiting the transport of essential elements in fungal cells. Prescription only. Available in 1% cream and lotion.
Adult
Massage into affected areas bid; reevaluate diagnosis if no improvement after 4 wk
Pediatric
Administer as in adults
None reported
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
For external use only; avoid contact with eyes and other internal routes
Itraconazole (Sporanox)
Fungistatic activity. Synthetic triazole antifungal agent that slows fungal cell growth by inhibiting cytochrome P450-dependent synthesis of ergosterol, a vital component of fungal cell membranes. Widely used and well-studied oral antifungal that can be used in the treatment of tinea cruris. Studies have shown that it is tolerated better than griseofulvin. Best results are noted 2-3 wk after the end of treatment.
Adult
200 mg PO qd for 1 wk; not to exceed 400 mg/d; increase in 100-mg increments if no improvement (administer >200 mg/d in divided doses)
Pediatric
5 mg/kg/d PO for 1 wk
Avoid alcohol because disulfiramlike reactions may occur; antacids may reduce absorption; rhabdomyolysis may occur with coadministration of HMG-CoA reductase inhibitors; coadministration with cisapride may cause cardiac arrhythmia; coadministration with midazolam or triazolam may increase their plasma levels
Documented hypersensitivity; may not be taken in conjunction with cisapride, midazolam, triazolam, and lovastatin
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Adverse effects include headache, nausea, vomiting, reversible elevation of liver enzymes, hepatotoxicity, hallucinations, hypokalemia, and edema
Sulconazole (Exelderm)
Broad-spectrum antifungal agent. Inhibits synthesis of ergosterol, causing cellular components to leak, resulting in fungal cell death.
1% cream or solution.
Adult
Apply topically to affected area qd for 2-4 wk
Pediatric
<12 years: Not established
>12 years: Administer as in adults
None reported
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
For external use only; avoid contact with eyes and other internal routes
Griseofulvin (Fulvicin-U/F, Grifulvin-V)
Fungistatic activity. Fungal cell division is impaired by interfering with microtubule. Binds to keratin precursor cells. Keratin gradually is replaced by noninfected tissue, which is highly resistant to fungal invasions.
Less effective than itraconazole in treatment of tinea cruris.
Adult
500 mg microsize (330-375 mg ultramicrosize) PO qd or divided bid for 2-4 wk
Pediatric
10-25 mg/kg/d PO; 20 mg microsize/kg/d (5 mg/lb/d) PO or 7.3 mg ultramicrosize/kg/d (3.3 mg/lb/d) PO
Avoid alcohol because disulfiramlike reactions may occur; intense UV light exposure may result in phototoxic reactions; may decrease hypoprothrombinemic activity of warfarin; contraceptives may lose effectiveness; may reduce effects of cyclosporine; may decrease serum salicylate concentrations; barbiturates may decrease serum griseofulvin levels
Documented hypersensitivity; do not administer with cisapride
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
On prolonged therapy, observe patients closely; monitor renal, hepatic, and hematopoietic function regularly; lupuslike syndromes or exacerbation of lupus erythematosus may occur; photosensitivity may occur; therefore advise patients to take protective measures against exposure to UV light or sunlight
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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Further Reading
Keywords
tinea cruris, tinea inguinalis, groin dermatophytosis, ringworm of the groin, gym itch, eczema marginatum, dhobie itch, jock itch, crotch rot,
