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.
Physical Examination
Tinea cruris manifests as a symmetric erythematous rash in the groin, as shown in the images below.
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. [7] 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. [8] 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%). [7] 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.
Complications
Tinea cruris can become infected secondarily by candidal or bacterial organisms. In addition, the area can become lichenified and hyperpigmented in the setting of a chronic fungal infection.
Mistreatment of tinea cruris with topical steroids can result in exacerbation of the disease. Although patients may note initial relief of symptoms, the infection may spread.
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Tinea cruris.
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Tinea cruris.
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Tinea cruris.
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Tinea cruris (hematoxylin and eosin stain).
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Tinea cruris (periodic acid-Schiff stain, magnification X 20).
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Tinea cruris (Gomori methenamine-silver stain, magnification X 20).
