a case of patient with complaints of itchy rash on her groin area

1. CASE DISCUSSION
Tinea Cruris
Itchy Groins

2. REFERENCE
Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology,
7th Edition
Diagnosis and Management of Tinea Infections
• 2014 American Academy of Family Physicians

3. OVERVIEW
• AKA jock itch, affects the portion of the
upper thigh opposite the scrotum or
labia
• Subacute or chronic dermatophytosis of
the upper thigh and adjacent inguinal
and pubic regions.
• A better name is tinea inguinalis (groin);
cruris refers to the lower leg.

4. Clinical Presentation
• Months to years duration. Often, history of long-standing tinea
pedis and prior history of tinea cruris.
• Large, scaling, well-demarcated dull red/tan/ brown plaques.
• Central clearing.
• Papules, pustules may be present at margins: dermatophytic
folliculitis.
• Treated lesions: lack scale; postinflammatory hyperpigmentation
in darker-skinned persons.

5. Clinical Presentation
• In atopics, chronic scratching may
produce secondary changes of lichen
simplex chronicus.
• Distribution. Groins and thighs; may
extend to buttocks
• Scrotum and penis are rarely involved

6. Laboratory
• A Wood lamp examination may be helpful to distinguish tinea from
erythrasma
• erythrasma (Corynebacterium minutissimum) exhibits a coral red
fluorescence.
• However, results of the Wood lamp examination can be falsely
negative if the patient has bathed recently.

7. DIFFERENTIAL DIAGNOSIS
Candidal
intertrigo
Involves scrotum; satellite lesions; uniformly red without
central clearing
Erythrasma Red-brown; no active border; coral red fluorescence with
a Wood lamp examination
Inverse psoriasis Red and sharply demarcated; may have other signs of
psoriasis such as nail pitting
Seborrheic
dermatitis
Greasy scale on erythematous base with typical
distribution involving nasolabial folds, hairline, eyebrows,
postauricular folds, chest; annular lesions less common

8. DIAGNOSIS
• Made on history, clinical findings, hair pull, and possible biopsy,
excluding other causes.

9. MANAGEMENT
Topical creams
• Terbinafine (lamisil)
• Butenafine (lotrimin)
Oral antifungal agents:
• extensive disease
• failed topical treatment
• immunocompromised
patients

10. PREVENTION
• After eradication, minimize reinfection with shower shoes
and antifungal powders