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%, and should be considered for this 75-year-old male patient with dementia in long-term care. According to the study published in Pediatrics in 2017 1, terbinafine 1% cream has been used effectively to treat tinea cruris, and its efficacy is superior to other over-the-counter alternatives. While clotrimazole 1% BID for 4 weeks is a common treatment, the evidence suggests that terbinafine 1% cream applied daily for 1 week is a more effective and efficient treatment option.
- Key considerations for treatment include:
- Keeping the affected groin area clean and dry before application
- Continuing treatment for the full duration, even if symptoms improve earlier, to prevent recurrence
- Caregivers assisting with application and maintaining good hygiene practices, given the patient's dementia
- Using breathable cotton underwear and avoiding tight clothing to reduce moisture and friction in the area
- If no improvement is seen after 1 week or if the condition worsens, reassessment may be necessary to consider alternative treatments or to rule out other conditions, and monitoring for any skin irritation or allergic reactions to the medication is crucial.
From the Research
Treatment of Tinea Cruris
- The patient is being treated with Clotrimazole 1% BID for 4 weeks, which is a common topical antifungal treatment for tinea cruris 2.
- However, studies have shown that oral antifungal drugs may be more effective in treating tinea cruris, especially in cases where the infection is severe or widespread 3, 4.
- One study found that itraconazole was the most effective oral antifungal drug in treating tinea cruris, with a cure rate of 66% at 8 weeks 3.
- Another study found that fluconazole 150 mg once weekly for 2-4 weeks was an efficacious and safe regimen in the treatment of tinea corporis and cruris 4.
Considerations for Patients with Dementia
- Patients with dementia in long-term care may require special consideration when treating tinea cruris, as they may have difficulty following treatment regimens or reporting symptoms 5.
- The use of oral antifungal drugs may be preferred in these patients, as they may be easier to administer and monitor than topical treatments 6.
- However, the safety and efficacy of oral antifungal drugs in patients with dementia have not been extensively studied, and caution should be exercised when using these medications in this population 6.
Alternative Treatment Options
- Terbinafine is another oral antifungal drug that has been shown to be effective in treating tinea cruris, and may be a useful alternative to itraconazole or fluconazole 3, 6.
- Topical clotrimazole may still be a useful treatment option for patients with mild or localized tinea cruris, especially if they are unable to tolerate oral antifungal drugs 2.