What is the treatment for tinea cruris?

From the Guidelines

Tinea cruris should be treated with terbinafine 1% cream applied daily for 1 week, which has been shown to have a mycological cure rate of approximately 94% 1. The treatment of tinea cruris typically involves the use of topical antifungal medications.

• Key options include:
  • Terbinafine 1% cream, which is approved for children 12 years and older and has been used effectively to treat tinea cruris 1
  • Butenafine, a benzylamine derivative of clotrimazole, applied twice daily for 2 weeks, although it is only approved for adults
  • Clotrimazole applied twice weekly for 4 weeks, which is an over-the-counter alternative
• For severe or resistant cases, oral antifungals such as itraconazole (100 mg daily for 2 weeks or 200 mg daily for 1 week) may be necessary, as it has been shown to be effective in adults and superior to oral griseofulvin 1. It is essential to continue treatment for at least one week after symptoms resolve to prevent recurrence and to keep the groin area clean and dry during treatment.
• Additional measures to help prevent recurrence include:
  • Wearing loose cotton underwear
  • Avoiding sharing towels
  • Changing clothes after sweating These measures help because the fungus (typically Trichophyton rubrum) thrives in warm, moist environments. Most cases of tinea cruris resolve completely with proper treatment and preventive measures, as supported by the high mycological cure rate of terbinafine 1% cream 1.

From the FDA Drug Label

Uses • cures most athlete's foot (tinea pedis) • cures most jock itch (tinea cruris) and ringworm (tinea corporis) • relieves itching, burning, cracking and scaling which accompany these conditions The treatment for tinea cruris (jock itch) is terbinafine (TOP), which cures most cases and relieves accompanying symptoms such as itching, burning, cracking, and scaling 2.

From the Research

Treatment Options for Tinea Cruris

• Topical antifungal treatments are generally successful for tinea cruris, unless the infection covers an extensive area or is resistant to initial therapy 3.
• Oral antifungal agents, such as terbinafine and itraconazole, can be used to treat tinea cruris, especially in cases where topical treatment is not effective 4.
• Fluconazole has been shown to be an efficacious and safe regimen in the treatment of tinea corporis and cruris, with a once weekly dose of 150 mg for 2-4 weeks 5.

Effectiveness of Topical Treatments

• Terbinafine has been shown to have a statistically significant higher clinical cure rate compared to placebo, with a risk ratio of 4.51 6, 7.
• Naftifine 1% has been shown to have a higher mycological cure rate compared to placebo, with a risk ratio of 2.38 6.
• Clotrimazole 1% has been shown to have a higher mycological cure rate compared to placebo, with a risk ratio of 2.87 6.

Comparison of Oral Antifungal Agents

• Itraconazole and terbinafine have been shown to be equally effective and safe in the treatment of tinea cruris and tinea corporis, with mycological cure rates of 91.8% and 74.3%, respectively 4.
• Clinical global improvement was better with itraconazole compared to terbinafine 4.

Safety and Adverse Effects

• Topical antifungal treatments have been shown to have minimal adverse effects, mainly irritation and burning 6, 7.
• Oral antifungal agents, such as terbinafine and itraconazole, have been shown to have mild adverse effects, such as gastrointestinal upset, headache, and taste disturbances 4.