Treatment of Jock Itch (Tinea Cruris)

Topical terbinafine is the first-line treatment for jock itch, applied once daily for 1 week. 1

First-Line Treatment

Apply topical terbinafine cream once daily (morning or night) for 1 week as directed by the FDA label 1
Wash the affected skin with soap and water and dry completely before applying the medication 1
Wash hands after each application to prevent spread of infection 1
Continue treatment for at least one week after clinical clearing of infection to ensure complete eradication 2

Azole antifungals (e.g., clotrimazole, miconazole) are effective alternatives with similar mycological cure rates to allylamines 3
Topical azoles typically require a longer treatment duration of 2-4 weeks compared to allylamines 2, 4
For cases with significant inflammation, combination antifungal/steroid agents may provide faster symptom relief, but should be used with caution due to potential for steroid-associated complications 2

For extensive infection or cases resistant to topical therapy, consider oral antifungals 5:
- Fluconazole: 150 mg once weekly for 2-3 weeks 5
- Itraconazole: 100 mg daily for 2 weeks or 200 mg daily for 7 days 5
- Terbinafine: 250 mg daily for 1-2 weeks 5

Keep the groin area clean and dry to create an unfavorable environment for fungal growth 6
Wear loose-fitting cotton underwear to reduce moisture and heat in the groin area 6
Change underwear at least once daily, especially after sweating 6
Avoid sharing personal items like towels and clothing to prevent transmission 6

After successful treatment, continue preventive measures to avoid recurrence 6:
- Apply antifungal powder to the groin area after bathing, especially during hot weather or before exercise 6
- Thoroughly dry the groin area after bathing or swimming 6
- Avoid wearing tight-fitting clothing for prolonged periods 6

Clinical improvement should be evident within the first week of treatment 2
If no improvement is seen after 2 weeks of appropriate therapy, reconsider the diagnosis or evaluate for complicating factors 2
For recurrent infections, consider screening and treating close contacts who may be asymptomatic carriers 7

Failure to complete the full course of treatment even after symptoms resolve can lead to recurrence 2
Misdiagnosis of other conditions (e.g., candidiasis, seborrheic dermatitis, psoriasis) as tinea cruris can lead to treatment failure 3
Excessive moisture in the groin area from inadequate drying or occlusive clothing can perpetuate infection despite appropriate antifungal therapy 6
Using topical steroids alone without antifungals can worsen the infection and lead to a condition called tinea incognito 2