From the Guidelines
For persistent tinea cruris (jock itch) that hasn't responded to clotrimazole, switching to terbinafine 1% cream applied daily for 1 week is the most effective treatment option, with a mycological cure rate of approximately 94% 1. When considering treatment options, it's essential to prioritize those with the highest cure rates and fewest side effects.
- Terbinafine 1% cream is approved for children 12 years and older and has been shown to be effective in treating tinea cruris 1.
- Other alternatives, such as butenafine applied twice daily for 2 weeks or clotrimazole applied twice weekly for 4 weeks, may also be effective but have lower cure rates or are only approved for adults 1.
- 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 tinea cruris and may be considered in severe cases 1. In addition to medication, it's crucial to keep the affected area clean and dry, wear loose cotton underwear, and change clothes after sweating to help prevent the spread of the infection and promote healing.
- Washing with gentle soap, thoroughly drying the area after bathing, and applying antifungal powder to help absorb moisture can also aid in the treatment of tinea cruris. If symptoms persist beyond 2 weeks of treatment, it's essential to seek medical attention to rule out other conditions, such as bacterial infections or dermatitis, and to determine the best course of treatment, which may include combination therapy with antifungals and low-potency corticosteroids to address inflammation.
From the Research
Treatment Options for Persistent Tinea Cruris
- For patients with persistent tinea cruris despite use of clotrimazole, alternative treatment options can be considered, including terbinafine, naftifine, and itraconazole 2, 3, 4, 5, 6
- Terbinafine has been shown to be effective in treating tinea cruris, with higher clinical cure rates compared to placebo 2, 4
- Naftifine has also been found to be effective in treating tinea cruris, with significant improvements in mycological cure and clinical success rates compared to vehicle 5
- Itraconazole has been compared to griseofulvin in the treatment of tinea corporis/cruris and tinea pedis/manus, and has been shown to be more effective in achieving mycological cure and clinical response 6
- In cases where oral antifungal drugs are considered, itraconazole has been found to be the most effective, followed by fluconazole, terbinafine, and then griseofulvin 3
Considerations for Treatment
- The choice of treatment should be based on the severity of the infection, the patient's medical history, and the potential for adverse effects 2, 3, 4, 5, 6
- Treatment duration and frequency may vary depending on the specific medication and the severity of the infection 2, 4, 5, 6
- Patients should be monitored for adverse effects and treatment outcomes, and adjustments to treatment should be made as needed 2, 3, 4, 5, 6