What is the diagnosis and treatment for Tinea cruris (Jock itch)?

From the Guidelines

Tinea cruris can be effectively treated with terbinafine 1% cream applied daily for 1 week, resulting in a mycological cure rate of approximately 94%. When considering treatment options for Tinea cruris, it is essential to prioritize those with the highest efficacy and safety profiles. According to the study published in Pediatrics in 2017 1, terbinafine 1% cream is a highly effective treatment for Tinea cruris, with a mycological cure rate of approximately 94%. Some key points to consider when treating Tinea cruris include:

• The use of topical antifungals such as terbinafine 1% cream, which has been shown to be effective in treating Tinea cruris 1
• The importance of completing the full treatment course, even if symptoms improve sooner, to ensure complete eradication of the infection
• The potential use of oral antifungals such as itraconazole for severe or extensive infections, which has been shown to be effective in adults 1
• The need for preventive measures, such as keeping the groin area clean and dry, to reduce the risk of recurrence. It is also worth noting that other treatment options, such as butenafine and clotrimazole, are available, but terbinafine 1% cream is a highly effective and recommended treatment option 1.

From the FDA Drug Label

Griseofulvin oral suspension, USP is indicated for the treatment of dermatophyte infections of the skin not adequately treated by topical therapy, hair and nails, namely: Tinea corporis Tinea pedis Tinea cruris Tinea barbae Tinea capitis Tinea unguium when caused by one or more of the following species of fungi: Note: Prior to therapy, a dermatophyte should be identified as responsible for the infection Prior to initiating treatment, appropriate specimens for laboratory testing (KOH preparation, fungal culture, or nail biopsy) should be obtained to confirm the diagnosis

Tinea cruris treatment: Griseofulvin is indicated for the treatment of Tinea cruris, but only when caused by a dermatophyte infection.

• The medication should be continued until the infecting organism is completely eradicated, as indicated by appropriate clinical or laboratory examination.
• Dosage: The recommended dosage for adults is 0.5 g daily, and for pediatric patients (older than 2 years), a dosage of 10 mg/kg daily is usually adequate 2, 2.

From the Research

Treatment Options for Tinea Cruris

• Tinea cruris, also known as jock itch, is a fungal infection of the skin in the groin area 3, 4, 5, 6, 7.
• Various treatment options are available, including topical and oral antifungal medications.

Topical Treatments

• Topical 1% butenafine and 1% clotrimazole have been compared in a randomized, double-blind trial for the treatment of tinea cruris and tinea corporis 7.
• Butenafine exhibited higher clinical cure rates compared to clotrimazole at the end of 1 week, but the difference was not statistically significant at 4 and 8 weeks of treatment 7.

Oral Treatments

• Fluconazole has been investigated as a treatment option for tinea corporis and cruris, with a study showing that 150 mg once weekly for 2-4 weeks is an efficacious and safe regimen 3.
• Terbinafine and itraconazole have also been compared in a prospective, randomized comparative study, with itraconazole showing better clinical global improvement and mycological cure rates 6.
• A study comparing the efficacy of 250 mg versus 500 mg oral terbinafine in the treatment of tinea corporis and cruris found that the higher dose did not have any additional benefit 4.
• A randomized pragmatic trial found that oral itraconazole is the most effective drug among fluconazole, griseofulvin, itraconazole, and terbinafine in the treatment of chronic and chronic relapsing dermatophytosis in India 5.

Efficacy and Safety

• The efficacy and safety of oral antifungal drugs, including fluconazole, griseofulvin, itraconazole, and terbinafine, have been evaluated in various studies 3, 4, 5, 6.
• While these drugs have shown some efficacy in treating tinea cruris and other dermatophytic infections, resistance to these drugs is being seen increasingly when used in conventional doses and duration 5, 6.