What is the treatment for tinea cruris (jock itch)?

From the Guidelines

Terbinafine 1% cream applied daily for 1 week is the most effective treatment for tinea cruris, with a mycological cure rate of approximately 94%. This treatment option is approved for children 12 years and older and has been shown to be effective in managing T cruris infection 1.

Treatment Options

• Topical antifungal medications such as terbinafine 1% cream, butenafine, and clotrimazole are available over-the-counter and can be used to treat tinea cruris.
• Oral itraconazole (100 mg daily for 2 weeks or 200 mg daily for 1 week) has been shown to be effective in adults for treating T cruris and is superior to oral griseofulvin (500 mg daily for 2 weeks) 1.

Management

• Apply the chosen antifungal medication to the affected area as directed, typically twice daily for 2-4 weeks.
• Continue treatment for at least one week after symptoms resolve to prevent recurrence.
• Keep the groin area clean and dry, wear loose-fitting cotton underwear, and avoid sharing personal items to prevent reinfection.

Considerations

• Butenafine is only approved for use in adults, while terbinafine 1% cream is approved for children 12 years and older 1.
• Oral antifungals such as itraconazole are reserved for extensive or resistant cases of tinea cruris.

From the FDA Drug Label

Directions clean the affected area and dry thoroughly apply a thin layer of the product over affected area twice daily (morning and night) or as directed by a doctor for athlete's foot & ringworm, use daily for 4 weeks; Uses for the cure of most athlete's foot, jock itch and ringworm

• Treatment for Tinea Cruris (Jock Itch): Apply a thin layer of miconazole (TOP) over the affected area twice daily for 2 weeks 2.
• Key Points:
  • Clean and dry the affected area before application
  • Use as directed by a doctor if necessary
  • If conditions persist longer than 2 weeks, consult a doctor 2
  • Miconazole (TOP) is used for the cure of most jock itch 2

From the Research

Treatment Options for Tinea Cruris

• Topical antifungal agents, such as allylamines (naftifine and terbinafine) and azoles (clotrimazole, econazole, ketoconazole, oxiconazole, miconazole, and sulconazole), are effective in treating tinea cruris 3
• Oral antifungal agents, such as fluconazole, itraconazole, and terbinafine, can be used to treat tinea cruris, especially in cases of extensive or resistant infections 4, 5, 6
• The choice of treatment depends on factors such as patient compliance, medication accessibility, and cost 3

Efficacy of Treatment Options

• A study found that fluconazole 150 mg once weekly for 2-4 weeks is an efficacious and safe regimen in the treatment of tinea corporis and cruris 4
• Another study found that itraconazole is more effective than terbinafine in treating tinea cruris, with a mycological cure rate of 91.8% compared to 74.3% 5
• A randomized pragmatic trial found that oral itraconazole is the most effective drug in treating chronic and chronic relapsing dermatophytosis in India, followed by fluconazole, terbinafine, and griseofulvin 6

Treatment Duration and Regimen

• Topical therapy is generally successful unless the infection covers an extensive area or is resistant to initial therapy, in which case systemic therapy may be required 7
• Treatment should continue for at least one week after clinical clearing of infection 7
• The duration of treatment with oral antifungal agents can vary, but a study found that 8 weeks of treatment with itraconazole was more effective than 4 weeks of treatment 6