Tinea Cruris, irritation or something else

I have what looks like a rash or fungal infection in my groin / inner thigh area. The skin is red, discoloured and flakes if rubbed, but it is not particularly itchy. I tend to sweat a lot, workout 4-5 a week, showering right after. I had a prescription for Nizoral which I applied to the area for a reasonable amount of time but it didn't alleviate the symptoms. I picked up some clotrimazole which I know is weaker and didn't do anything either. It has been like this for a year or more. I am trying rubbing alcohol and hydrocortisone cream.

Is this a persistent fungus or something else? My thighs rub together so I would not be surprised if this is some kind of irritation.

[Bhupinder Kaur, MD]

Hello,

I cannot confirm anything without examination but it can be due to eczema.But the other possibilities are contact dermatitis(to the texture of cloth of bra),sweat dermatitis, friction rub of the skin, or fungal infections.

Eczema is a form of chronic dermatitis (rash).Allergic reaction is one of the important causes of eczema.

Wash your groin daily and then dry thoroughly by pat drying,not rubbing. A hairdryer is useful if you have hairy groins.The damp groin is an aggravating factor.Also wear cotton underwears and change them twice a day and do not share other people’s towels. Do not use any cosmetic products at the sites. You can apply some calamine lotion at the rash as it will help in soothing the skin. You can take some OTC oral antihistamine medications like Benadryl or Claritin and see if it helps.

For mild-moderate symptoms a weak steroid may be used (e.g. hydrocortisone as dermacort), whilst more severe cases require a higher-potency steroid (e.g. clobetasol propionate, fluocinonide).

If the symptoms still persist then pls consult a dermatologist and get the lesion biopsied.Fungal infections have to be ruled out then.

Hope it helps.Take care and pls do keep me posted if you have any additional queries.Kind regards.

[blahzay]

Is erythrasma a possibility?

[Bhupinder Kaur, MD]

Hello,

Erythrasma is a chronic superficial infection of the intertriginous areas of the skin.It is true that groins are effected but the typical appearance is well-demarcated, brown-red macular patches. The skin has a wrinkled appearance with fine scales.

It has to be differentiated from contact dermatitis,psoriasis,sweat dermatitis and fungal infections which may mimic it.Wood lamp examination and gram staining are the tests for its diagnosis.

So nothing can be confirmed without examination.

Hope it helps.Take care and pls do keep me posted on how you are doing or if you have any additional queries.Kind regards.

[blahzay]

Thank you again for your help.

Given there has been no improvement from antifungal medication, and that the brown/red/wrinkled description you provide as well as what I've read on erythrasma is consistent with the symptoms, I'm inclined to think it is something other than a fungal infection. I know someone with psoriasis and this seems very different. But as you say the exact diagnosis and treatment selection requires examination e.g. wood lamp test.

In the meantime do you think the rubbing alcohol + hydrocortisone approach is worth continuing or harmful/ineffective?

[Bhupinder Kaur, MD]

Hello,

The standard therapy of erythrasma is antibiotics and antifungals because it is caused by a bacteria C minutissimum.Erythromycin is the drug of choice.

Mild steroids are helpful in reducing the inflammation associated with it.But use it only after a dermatologist,s prescription.

Hope it helps .Take care and pls do keep us posted in case you have any additional queries.Kind regards.