Jock Itch
Do you have to be a jock to itch?
Nope. If you have an area on your body that remains moist from sweating or bathing, your body could end up hosting a yeast or fungus, including the one commonly called jock itch. The groin area, where darkness, warmth, and moisture are abundant, is the perfect environment for the growth of this condition.
Synonyms
- Tinea cruris
- Ringworm
Detailed Description
Usually limited to the groin area and upper and inner thighs, jock itch inhabits the topmost layer of the skin, creating an itchy, often painful experience. Jock itch produces well-defined, red, ring-like areas, sometimes with scaling (flaking) or occasionally small blisters in the skin around the groin and over the thighs.
It's fairly common and is seen more frequently in men than in women and turns up more frequently in warm weather and high humidity. Though it can occur at any age, it is rare before puberty. It is also contagious. It can move to other moist areas on the body or from person to person by direct contact with the infected site.
This uncomfortable condition is usually cleared up with over-the-counter -- or in stubborn cases prescription -- antifungal creams. Serious or stubborn infections may require prescription oral medications.
What You Can Expect
In some cases, excessive scratching may cause a secondary bacterial infection manifesting itself as oozing from the blistered skin. Oral or topical antibiotics are often prescribed to treat the infection.
Even with the best treatment, jock itch can recur, especially if the groin area and thighs stay moist. Fungi can survive indefinitely on the skin.
Established Causes
Jock itch is caused by infections of many different types of fungi, such as:
- Epidermophyton floccosum
- Trichophyton interdigitale
- Trichophyton mentagrophytes
- Trichophyton rubrum
- Trichophyton verrucosum (rare)
Drugs That Can Cause or Aggravate Jock Itch
Jock itch is caused by a fungus. Patients whose immune systems are suppressed by medications (or disease) may be at a higher risk.
Risk Factors
Some general risk factors for acquiring jock itch are:
- Lots of sweating during the summer months
- Wearing damp clothing
- Wearing multilayered, tight clothing
- Immunodeficiency
- Being overweight
Risk factors are traits or behaviors that may make you statistically more likely than others in the general population to have a certain condition. They are not necessarily "causes" of the condition.
Symptoms
These signs and symptoms accompany jock itch:
- Irritation caused from wearing certain clothing
- Skin is red, raised, and scaling, occasionally blistering
- Involved skin can be itching or not
Conditions That May Be Mistaken for Jock Itch
Jock itch must be distinguished from other skin conditions found in the groin region, such as:
- Intertrigo: infection of the skin folds with bacteria, yeast, and fungi, causing increased inflammation and fissures within the folds
- Erythrasma: brown or red scaly plaques involved in the groin, mainly caused by bacterial infection with Corynebacterium minutissimum
- Seborrheic dermatitis
- Psoriasis
- Candidiasis
How Jock Itch Is Diagnosed
Diagnosis starts with your account of the symptoms as well as the onset of the condition. Physical examination looks for the characteristic location and appearance. Skin scrapings (KOH prep) and cultures confirm the diagnosis.
Goals of Treatment
Jock itch can be temporarily cured. If prevention or eradication is not complete, then there is a possibility of recurrence, so proper measures must be followed.
With treatment you can expect to eradicate the fungi, relieve the itching and pain, and, if you keep the infected areas clean and dry, reduce the chance of recurrence.
Treatment Overview
Jock itch can be treated at home with over-the-counter antifungal creams applied twice daily for as long as two weeks after the condition has cleared up. Keep the infected areas clean and dry, to stop further growth as well as to allow the skin to heal. Wash the areas with soap and water, then dust with talcum powder or antifungal powders. Avoid using powders that contain cornstarch, as fungi like cornstarch. Related bacterial infections are treated with a variety of antibiotics prescribed by a doctor. Finding ways to decrease perspiration and increase evaporation are important preventive measures.
Drug Therapy
If you have a severe case of jock itch, your doctor may prescribe oral medications such as griseofulvin, ketoconazole, itraconazole, terbenitine, or fluconazole. Although effective, both may cause side effects including headaches, upset stomach, sensitivity to light, rashes, swelling, and liver problems.
Drugs most commonly prescribed
Topical antifungal medications used for jock itch include:
- Imidazoles
- Mycelex (clotrimazole)
- Monistat (miconazole)
- Spectazole (econazole)
- Nizoral (ketoconazole)
- Oxistat (oxiconazole)
- Exelderm (sulconazole)
- Allylamines:
- Naftin (naftifine)
- Lamisil (terbinafine)
Second choices
When infection is severe or persistent, oral antifungal medications may be used, such as:
- Grifulvin V (griseofulvin)
- Nizoral (ketoconazole)
- Lamisil tablets (terbinafine)
- Sporanox (itraconazole)
Monitoring the Condition
A liver function blood test and complete blood count (CBC) may be recommended prior to therapy and at regular intervals during therapy for those taking oral antifungal medications.
Possible Complications
Jock itch may involve these complications:
- Slow healing
- Secondary bacterial infection
- Liver damage (rarely, with the use of griseofulvin or ketoconazole)
Activity and Diet Recommendations
Keep the affected area as dry as possible.
Considerations for Children and Adolescents
Jock itch is rare in children prior to puberty.
Considerations for Older People
Some of the nuisances of old age-- diminished immune function, incontinence, difficulty maintaining personal hygiene due to other impairments-- can help set the stage for jock itch.
Herbs
- Tea tree oil: This Australian plant may have some antifungal action. At the University of Rochester School of Medicine in New York, researchers studied 117 people with fungal toenail infections, a condition related to jock itch but more difficult to treat. The participants applied either a standard drug (clotrimazole) or tea tree oil at 100% strength twice a day for six months. Both treatments produced equally good results. [1] Be aware there is increasing incidence (about 10%-20%) of sensitivity (contact allergy) to tea tree oil.
- Garlic: contains antifungal compounds. Several studies show that its juice is effective against fungal infections. [2] Crush several cloves into a small amount of water or vegetable oil and let the mixture sit overnight. Apply with a cotton swab once or twice a day. The drawback with this treatment is that you may wind up smelling of garlic, and it may cause irritant dermatitis.
1 Buck, D.S., et al. "Comparison of Two Topical Preparations for Treatment of Onychomycosis: Melaleuca Alterniflora (Tea Tree Oil) vs. Clotrimazole," J. Fam. Pract. (1994) 38:601.
2 Venugopal, P.V. and T.V. Venugopol. "Antidermatophytic Activity of Garlic in Vitro," Int. J. Dermatol (1995) 34:278.
Preventing Jock Itch
The following measures not only prevent jock itch, they also help get rid of it.
- Avoid the fungus that causes jock itch. It's contagious. Don't share towels or soap.
- Stay dry. Keep target areas -- the groin and thighs -- and secondary areas, such as the toes, clean and dry. Don't sit around in a wet bathing suit. The fungus needs moisture to grow. Use a blow dryer after bathing and towel drying. Dust yourself with a non-cornstarch powder to absorb excess moisture.
- Wear absorbent, loose-fitting underwear. Men should also wear clean, dry athletic supporters when needed. Natural fibers (cotton, wool) help keep the skin dry better than synthetics. Change your underwear daily.
Websites & Organizations
American Academy of Family Physicians Foundation
P.O. Box 8418
Kansas City, MO 64114
Phone: 800-274-2237, ext. 4400
Arnot Ogden Medical Center
Centers for Disease Control and Prevention
1600 Clifton Rd., NE
Atlanta, GA 30333
Phone: 404-639-3311
Health Answers
Multnomah County Health Department
Public Health Care Information
The Office of Disease Prevention and Health Promotion
National Health Information Center
P.O. Box 1133
Washington, DC 20013-1133
Phone: 800-336-4979
The Skin Site
The Society for Investigative Dermatology
Suite 340, 820 West Superior Avenue
Cleveland, OH 44113-1800
Phone: 216-579-9300
Fax: 216-579-9333
Email: SID@SIDNET.org
Women's Dermatologic Society
930 North Meacham Road
Schaumberg, IL 60173
Phone: 847-330-9830
Fax: 847-330-1090
Email: kward@aad.org
Sources for This Article
Books
Balch, James F. and Balch, Phyllis A. Prescription for Nutritional Healing. Garden City Park, NY: Avery Publishing, 1997.
Bennett, J. Claude and Plum, Fred. Cecil Textbook of Medicine, eds. Philadelphia: W. B. Saunders, 1996.
Fauci, Anthony J. et. al. Harrison's Principles of Internal Medicine, eds. New York: McGraw-Hill, 1998.
Hardman, Joel G. and Limbird, Lee E. Goodman and Gilman's The Pharmacological Basis of Therapeutics eds. New York: McGraw-Hill, 1996.
Hurst, J. Willis. Medicine for the Practicing Physician eds. Stamford, CT: Appleton & Lange 1996.
Noble, John. Primary Care Medicine ed. St. Louis: Mosby, 1996.
Physicians' Desk Reference. Montvale, NJ: Medical Economics Co., 1998.
Rakel, Robert E. Conn's Current Therapy eds. Philadelphia: W.B. Saunders, 1998.
Taylor, Robert B. Family Medicine: Principles and Practice. New York: Springer-Verlag, 1998.
Tierney, LM, McPhee, SJ, and Papadakis, MA. Current Medical Diagnosis and Treatment eds. Stamford, CT: Appleton & Lange, 1998.
Articles
Bienias, L, Wlodarczyk, W. "Dermatomycoses and their Etiology in the Material of the Dermatological Department in L'od'z, Poland." Mycoses. 33(11-12):581-6. Nov-Dec 1990.
Buck, DS, et al. "Comparison of Two Topical Preparations for Treatment of Onychomycosis: Melaleuc Alterniflors (Tea Tree Oil) vs. Clotrimazole," J. Fam. Pract. (1994) 38:601.
Chakrabarti, A, Sharma, SC, Talwar, P. "Isolation of Dermatophytes from Clinically Normal Sites in Patients with Tinea Cruris." Mycopathologia. 120(3):139-41. Dec 1992.
del Palacio, A, Cu'etara, S, Rodr'iguez, Noriega A. "Topical Treatment of Tinea Corporis and Tinea Cruris with Eberconazole (WAS 2160) cream 1% and 2%: a Phase II Dose-finding Pilot Study." Mycoses. 38(7-8):317-24. Ju;-Aug 1995.
Drake, LA, Dinehart, SM, Farmer, ER, Goltz, RW, Graham, GF, Hardinsky, MK, Lewis, CW, Pariser, DM, Skouge, JW, Webster, SB, Whitaker, DC, Butler, B, Lowery, BJ, Elewski, BE, Elgart, ML, Jacobs, PH, Lesher, JL Jr, Scher, RK. "Guidelines of Care for Superficial Mycotic Infections of the Skin: Tinea Corporis, Tinea Cruris, Tinea Faciei, Tinea Manuum, and Tinea Pedis. Guidelines/Outcomes Committee. American Academy of Dermatology." J Am Acad Dermatol. 34(2 Pt 1):282-6. Feb 1996.
Farag, A, Taha, M, Halim, S. "One-week Therapy with Oral Terbinafine in Cases of Tinea Cruris/Corporis." Br J Dermatol. 131(5):684-6. Nov 1994.
Jordon, RE, Rapini, RP, Rex, IH Jr, Katz, HI, Hickman, JG, Bard, JW, Medansky, RS, Lew-Kaya, DA, Sefton, J, DeGryse, RE, et al. "Once-Daily Naftifine Cream 1% in the Treatment of Tinea Cruris and Tinea Corporis." Int J Dermatol. 29(6):441-2. Ju;-Aug 1990.
Kovacs, SO, Hruza, LL. "Superficial Fungal Infections. Getting Rid of Lesions that Don't Want to Go Away." Postgrad Med. 98(6):61-2, 68-9, 73-5. Dec 1995.
Pi'erard, GE, Arrese, JE, Pi'erard-Franchimont, C. "Treatment and Prophylaxis of Tinea Infections." Drugs. 52(2):209-24. Aug 1996.
Smith, EB. "Topical Antifungal Drugs in the Treatment of Tinea Pedis, Tinea Cruris, and Tinea Corporis." J Am Acad Dermatol. 28(5 Pt 1):S24-S28. May 1993.
van Heerden, JS, Vismer, HF. "Tinea Corporis/Cruris: New Treatment Options." Dermatology. 194 Suppl 1():14-8. 1997.
Venugopal, PV and TV Venugopol. "Antidermatophytic Activity of Garlic in Vitro," Int. J. Dermatol (1995) 34:278.