Warm and humid summer, troublesome jock itch

Since the beginning of summer, Mr. Li’s thighs have repeatedly itchy, and many ointments have been useless. In desperation, I came to the hospital for an examination. It turned out that it was the tinea cruris. Tinea cruris is easy to occur in the warm and humid season. Now it is summer, and many people suffer from tinea cruris. For this reason, the author will carefully talk about the prevention and treatment of tinea cruris.

Tinea corporis on wet skin “call your door”
Tinea cruris is a fungal infectious disease, often caused by Epidermophyton floccosum, Trichophyton mentagrophytes, Trichophyton rubrum, etc. It usually occurs in the skin of the thigh on the opposite side of the scrotum, on one or both sides, mostly in ring or semi-ring patches. A small piece of erythema appears on the inner side of the upper thigh, there is desquamation on it, and it gradually expands and spreads around, the boundary is clear, and there are papules, blisters, scabs, and itching on it.

Tinea cruris is mainly transmitted through contact. If there are fungi on the used items, then contact with these items may be infected. Therefore, tinea corporis is easily spread among people living together, such as university dormitories and employee dormitories. Fungi like dampness and are more likely to be found on towels, floors, carpets and toilet seats in the living environment.

Fungi can also multiply rapidly in humid and warm parts of the human body. Especially the skin folds are not conducive to sweat evaporation, and fungi can grow in this warm and humid environment. When the clothes are wet or too tight, tinea cruris may occur. For example, wearing tights or wet swimsuits for a long time in summer; or working, studying or exercising in a warm and humid climate, high humidity, poor perspiration, erythema, papules, and severe itching may appear on the inner thighs; long-term sitting may also occur Conducive to the occurrence of tinea cruris. If you suffer from Hong Kong foot (tinea pedis), the fungus on the foot goes retrograde, it will infect the groin and cause jock itch. In addition, obese people have obvious thigh folds, which is not conducive to sweat evaporation and are more likely to suffer from tinea cruris. People with weak immune systems also have difficulty preventing tinea cruris. Diabetes (high blood sugar) also puts people at risk of getting tinea cruris.

The diagnosis needs to be differentiated from other diseases
Some people think that tinea corporis is itchy, just scratch it and don’t need to go to the hospital. In fact, if scratching leads to skin breakage, it is easy to induce bacterial infection, erysipelas, redness, swelling, heat pain, and hospitalization. At this time, you need to take a variety of drugs to treat severe rashes. These drugs may cause stomach pain, nausea, vomiting, diarrhea, or rashes on other parts of the body.

Therefore, when there are clear boundaries, obvious inflammation, and scaly erythema in the groin, buttocks, and thigh roots, you should see a dermatologist. The doctor will ask the patient about the patient’s medical history. Questions that may be involved include whether they have tinea, foot, or other fungal infections, when the skin lesions appeared, how they looked when they first appeared, whether there was pain or itching, and whether they had had similar symptoms. Wait. Whether there are any other chronic diseases, such as diabetes; whether long-term use of glucocorticoid drugs, etc. are also questions that doctors will mention. In addition, the doctor will also ask the patient about his occupation, whether he participates in sports, whether he has been sitting for a long time, whether he sweats a lot, whether he wears tights or wet clothes for a long time. The doctor will simply observe the color, shape, and appearance of the skin lesions. If the symptoms are not typical, the doctor may recommend that the patient undergo fungal microscopy, or fungal culture and strain determination to further confirm the diagnosis.

It is worth noting that there are some clinical diseases similar to tinea cruris and need to be carefully identified.

1. Psoriasis mainly affects the scalp, toenails, and extensible skin of the trunk. The clinical manifestations are erythema, plaque and silvery white scales. If psoriasis grows in skin folds such as the groin, it is called reverse psoriasis. This is a genetically related chronic inflammatory disease caused by T lymphocyte mutations. The fungus test was negative.

2. Seborrheic dermatitis most often appears on the scalp and face, sometimes on the chest and skin folds. Also manifested as erythema, scales and papules. Mycological examination was negative.

3. Centrifugal annular erythema, which looks a lot like tinea corporis, also becomes a ring, gradually expanding outward. May be covered with following scales. This is a rare type of reactive skin erythema that can appear not only on the inner thigh, but also on the entire lower extremity. This disease can be related to many factors, such as visceral disease, drug and food exposure. The fungus test was negative.

4. Erythrasma and Candida disease, they are skin diseases caused by different microorganisms. Erythrasma is a skin disease caused by Corynebacterium parvum, which often appears in half of reddish brown at the skin folds. If the skin lesions show coral red fluorescence under the irradiation of a filtered ultraviolet lamp, it can be diagnosed as erythrasma. If there are red patches with satellite-shaped papules and pustules, it is indicative of candida disease. Potassium hydroxide smear or fluorescent staining can be used to observe Candida pseudohyphae, hyphae and yeast cells. Unlike tinea cruris, male patients with candidiasis in the thigh folds often have scrotum involvement.

5. Pityriasis rosea, this disease often appears on the trunk or limbs near the trunk, with variable numbers and sizes, round or oval rosy spots with sugar-like scales on them. Mycological examination was negative. Generally, it will subside on its own without recurrence after 4 to 8 weeks.

Mainly topical drugs, oral antifungal drugs when necessary
Tinea cruris generally does not heal by itself. The goal of treatment is to remove pathogenic bacteria, quickly relieve symptoms, repair skin lesions, and prevent recurrence. Treatment with external medications is the main treatment, with widespread skin lesions, severe or recurring skin lesions, and poor efficacy of external medications, oral antifungal therapy should be considered.

Common topical drugs include miconazole, ketoconazole, butenafine, bifonazole, amorolfine, terbinafine and so on. Some Chinese medicines, such as the fungicidal ointment made from jingpi, etc. can also be used.

It should be noted that the skin of the groin and inner thighs is thin, so it is not suitable to use alcohol-containing irritating potions, otherwise it will not only be extremely painful, but may also cause peeling.

Continue to use medication for more than 2 weeks or continue medication for 1 to 2 weeks after the skin lesions subsided to prevent recurrence. At the same time, attention should be paid to the reasonable selection of dosage forms, and special attention should be paid to infections with severe inflammation of the skin lesions to prevent irritation and aggravation of the disease.

If the topical medication does not work well, the oral medication can be used under the guidance of a doctor. For example, itraconazole capsules, 2 tablets a day for 1 to 2 weeks; terbinafine tablets, 1 tablet a day or 1 tablet every other day, for 2 weeks.

Do daily management to prevent recurrence of tinea cruris
It is worth mentioning that tinea cruris has a tendency to recur. Only when the erythema, papules, and scales have completely subsided, and the fungal microscopy and/or fungal culture are negative, it can be regarded as cured.

In addition, some patients may have temporary pigmentation after the skin lesions subsided. No special treatment is needed for melanin deposits on the inner thighs and groin. As long as the tinea cruris is under control, the pigmentation will gradually fade, but it may not return to its original state.

To prevent recurrence, patients with tinea cruris need to do daily management:

1. Keep it dry. Try to wear sweat-absorbing and breathable cotton clothing. Obese people should change clothes frequently, actively control their weight, and use powder to keep parts dry in areas prone to sweating.

2. Take a bath every day. After the shower, dry the skin thoroughly and use different towels to dry all parts of the body. If you often have tinea cruris, apply medicine and talcum powder as required after bathing.

3. Wash your hands frequently to prevent the spread of fungi. Especially for tinea pedis patients, remember to wash your hands after rubbing your feet to prevent the fungus from spreading from the feet to the hands and then to the inner thighs. Put on socks before putting on underwear so that you don’t spread the fungus from your feet to your groin.

4. Patients’ underwear should be disinfected regularly, such as washing, drying, and boiling.

5. Eat light, nutritious food to improve immunity.

6. If it is caused by contact with pets, the pets should be examined and treated for mycology, and the household items that the pets have touched should be disinfected