What is the treatment for Tinea cruris?

Treatment of Tinea Cruris

Tinea cruris should be treated with topical antifungal agents as first-line therapy, with oral antifungals reserved for extensive disease or when topical treatments have failed. 1

First-Line Treatment

Topical Antifungals

• Azole antifungals:

  • Econazole 1% cream: Apply once daily for two weeks 2
  • Clotrimazole 1% cream: Apply twice daily for 2-4 weeks 3
  • Miconazole, ketoconazole: Apply twice daily for 2-4 weeks 3

• Allylamine antifungals:

  • Terbinafine 1% cream: Apply once daily for 1 week 1
  • Butenafine: Apply twice daily for 2 weeks (for adults) 1

The fungicidal allylamines (terbinafine) and butenafine allow for shorter treatment duration compared to fungistatic azoles, but may be more costly 4

Second-Line Treatment (Extensive Disease or Treatment Failure)

Oral Antifungals

• Terbinafine: 250 mg once daily for 1 week 5

  • Highly effective with complete clinical and mycological clearance after 1 week

• Itraconazole: 100 mg daily for 2 weeks or 200 mg daily for 1 week 1

  • Superior to oral griseofulvin in treating tinea cruris

• Fluconazole: 150 mg once weekly for 2-4 weeks 6

  • Effective for multiple or extensive infection sites

Treatment Duration and Follow-up

• Continue treatment for at least one week after clinical clearing of infection 3
• Clinical improvement is typically seen soon after treatment begins, but complete the full course to prevent recurrence 2

Additional Measures for Prevention and Management

• Complete drying of the crural folds after bathing
• Use separate clean towels for drying the groin and other body parts
• Cover active foot lesions with socks before wearing undershorts to prevent spread from tinea pedis
• Wear loose-fitting clothing and change underwear daily 1

Important Clinical Considerations

• Confirm diagnosis with potassium hydroxide (KOH) preparation before initiating treatment when possible
• For inflamed lesions, short-term use of combination antifungal/steroid agents may be considered, but use with caution due to potential for atrophy 3
• If no clinical improvement is seen after the treatment period, reconsider the diagnosis 2

Treatment Algorithm

1. Confirm diagnosis (clinical + KOH if available)
2. Start with topical antifungal (terbinafine for shorter course or azole if cost is a concern)
3. If extensive disease or treatment failure, proceed to oral therapy
4. Continue treatment for at least one week after clinical clearing
5. Implement preventive measures to avoid recurrence