Runner

I am a runner who has developed a couple of fissures in a real unfortunate area.  Between my anus and scrotum is where the fissures developed from what I think are years of running.  I have been to my regular Doctor and he prescribed Triamcinolone Acetonide in combination with clotrimazole.  He said to rub the two together and put it down there.  Also, suggested was applying baby powder before I run.  The creams do work when I am not running.  The baby powder seemed to aggrevate the area.  Vasaline and runners lube did not help.  I have been regulated to walking and using the eliptical machine.  When I start running again it seems to come back.  I did go to my dermatologist the other day and all he suggested was a cream that was combined with similar ingredients to I did not have to mix the two.  He really is not in to running so I do not know if he could think of any solutions.  I have changed my clothing to non-cotton.  The only thing I have not tried is a new detergent or different diet.  I hesitate to use much soap down there.  As you can see I am stumped.  Is it possible that I am not applying enough of the cream at application.  I am a heavy sweater so there is a lot of friction I am sure.  But I would think the cream would take it away once and for all.  I forgot to ask the Doctors if that cream can be used indefinetly.   Thus, any ideas?

[Alan Rockoff, MD]

I have many runners in my practice and have never once encountered someone with a fissure in that area which couldn't be healed.  If the area is itchy, then rubbing and scratching could be involved, in which case no cream will solve the problem, at least long-term.  If not, then I think you ought to see a proctologist or rectal surgeon to see whether the fissure is very deep and needs more than external treatment.  I see no benefit from clotrmazole, which is antifungal, and what you have does not sound fungal.  Meantime, I suggest regular use of triamcinolone, covering it with plain vaseline,  minimizing friction, and otherwise leaving the area completely alone.

Take care.

Dr. Rockoff