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Psoriasis? On groin area and toenails
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Psoriasis? On groin area and toenails

Hello Doctor and forum,

I have a couple skin problems I need help diagnosing and treating.

About a year ago I had an apparent flare-up of jock itch (redness with raw burning feeling between thighs and groin).  As in the past, I used Micreme, which helped but never got completely rid of it this time.  After trying several natural/alternative treatments for fungal/jock itch (tea-tree oil, oregano oil, etc.), a doctor had me tested and found no fungal infection present, and prescribed Hydrocortison cream 1%, which again improved but never completely got rid of it.   There still remains a smooth, pink and slightly clammy appearance in the fold between thigh and groin, combined with a dry, scratchy appearance over upper inner thigh.  Since yesterday it has become more inflamed and the raw/stinging sensation has returned.  Also lately, separate to the rash in the groin area, small pinkish-red, splotchy patches have appeared on each of my inner thighs.  These first appear like mosquito bites, and itch sometimes.  They appear very similar to the Sebo-psoriasis(?) that once affected my trunk – e.g. same silvery sheen.

In addition, soon after this flare-up, I noticed a slight discolouration on a few toenails of one foot.  A white crusty substance formed under the nails, and the nails eventually became thickened and deformed, and are now brittle and broken away.  There is some dryness and slight peeling on the sole and in between the toes of the foot with the problem toenails.  Sometimes I get a slight itch on the toes when in the shower but not often.  Assuming it was a fungal infection/athletes foot, I again tried some natural remedies for fungal infection of the nails, followed by couple weeks of Micreme, without results.  Doctor ordered test for toenails which found no fungal infection, but prescribed nothing and referred me to dermatologist, whom I must wait 6 months to see.

I believe the toenail/foot problem, and possibly the groin rash, may have been triggered by extensive walking in damp shoes on a hot day, followed by a visit to a sauna.  

SOME RELEVANT HISTORY:
I first went to a dermatologist (Dr Michael Lebowitz) about 12 years ago for moderate acne (back, chest, face), and again for a rash over trunk which, though I was never certain, I believe was diagnosed as Sebo-psoriasis.  For the acne, I was prescribed Roaccutane, which worked well but required a few follow-up courses over following years.  For the rash/seb-psoriasis, I was eventually prescribed a special cream (LPC 3%, AC Sal 6% in Diprosone OV) that worked well at controlling outbreaks, which have been very rare in recent years.  I also found sun and seawater very beneficial.  In addition, at one subsequent visit the dermatologist prescribed a two-week oral treatment/anti-biotic for some sort of rash if I recall exactly.

For the past few years I have successfully used “Micreme H” to treat what I believed was reoccurring jock itch, though not inspected or tested by doctor.

In the last year doctor diagnosed me with Seborrheic Dermatitis on the chest and prescribed “Coco-scalp”, which I use every couple of months to keep under control.

Over the last year I have noticed on a couple occasions that the skin directly over my elbow was very dry and hard, itchy, and would peel easily.   The problem subsided after using moisturizer on affected area for about a week.

Thank-you for any help you can provide.

Regards,
Paul
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Doctor, I've included a few photos of the rash in my profile as I forgot to include in original post, please check them.

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