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Diseases and Conditions
Jock itch
From MayoClinic.com
Special to CNN.com

Introduction

Jock itch (tinea cruris) is a common fungal infection that affects the skin of your inner thighs, buttocks and genitals. Jock itch causes an itchy, red, often ring-shaped rash in these warm, moist areas of your body.

Jock itch is often caused by the same type of fungus that causes athlete's foot and sometimes ringworm of the scalp. In fact, the fungus that infects your groin area may be spread there from your own athlete's foot infection.

Jock itch gets its name because it is common in people who sweat a lot, like athletes. It also often occurs in people who are overweight, but anyone can get the infection.

Although often uncomfortable and bothersome, jock itch usually isn't serious, except possibly for people with weak immune systems. Keeping your groin area clean and dry and applying topical antifungal medications are usually sufficient to treat the problem.

Signs and symptoms

The signs and symptoms of jock itch may include:

  • Itching and redness in your groin, including your genitals, inner thighs, buttocks and anal area
  • Burning sensation in affected areas
  • Flaking, peeling or cracking skin in your groin

Jock itch can make wearing underwear or tight clothing uncomfortable. Walking or exercising may aggravate the rash and worsen your signs and symptoms.

Causes

Jock itch is caused by fungi called dermatophytes. These microscopic organisms are normal inhabitants of your skin, and stay in check as long as your skin is clean and dry. But on some areas of the body where skin is likely to be moist and warm, such asthe groin the fungi grow and thrive, resulting in a fungal infection.

Jock itch is only mildly contagious. It can spread from person to person by shared use of contaminated towels or clothing or through direct contact during sexual intercourse with someone who has the infection.

Risk factors

The organisms that cause jock itch thrive in damp, close environments. Warm, humid settings that promote heavy sweating — thus washing away fungus-killing oils, making the skin more permeable and in turn making the skin more prone to infection — favor its spread. Jock itch often affects men who wear tight underwear or athletic supporters that aren't washed after each use. People who are obese or sweat a lot also are at higher risk of jock itch. Some people may be genetically prone to this type of infection.

People with impaired immune systems — such as people with diabetes or HIV/AIDS —also may be at increased risk of jock itch. If you have atopic dermatitis — a chronic, inherited skin disease characterized by itchy, inflamed skin — you may be more susceptible to jock itch. The barriers in your skin that normally protect you from viral, bacterial and fungal infections often are weakened or compromised.

When to seek medical advice

See your doctor if you have a rash on your skin that doesn't improve within two weeks. You may need prescription medication. If excessive redness, swelling, drainage or fever occurs, see your doctor.

Screening and diagnosis

Your doctor can determine if you have jock itch or another skin disorder, such as dermatitis or psoriasis.

Your doctor may take skin scrapings or samples from the infected area and view them under a microscope. This is called a KOH examination. If a sample shows fungi, treatment may include an antifungal medication. If the test is negative, but your doctor still suspects that you have jock itch, a sample may be sent to a lab to determine whether it will grow fungi under the right conditions. This test is known as a culture. Your doctor may also order a culture if your condition doesn't respond to treatment.

Complications

A fungal infection rarely spreads below the surface of the skin to cause serious illness. However, people with weak immune systems, such as those with diabetes or HIV/AIDS, may find it difficult to get rid of the infection.

Treatment

Jock itch is treated with one of two types of antifungal medications — azoles or allylamines. Generally, allylamines require a shorter treatment time, while azoles are less expensive but require longer treatment time.

For a mild case of jock itch, your doctor may suggest first using an over-the-counter antifungal ointment, lotion, powder or spray. Most infections respond well to these topical agents:

Allylamines

  • Terbinafine (Lamisil AT)
  • Naftifine (Naftin)

Azoles

  • Miconazole (Micatin, Monistat-Derm)
  • Clotrimazole (Lotrimin AF)

If jock itch is severe or doesn't respond to over-the-counter medicine, you may need a prescription-strength topical or oral medication. These include:

Topical

  • Econazole (Spectazole)
  • Oxiconazole (Oxistat)

Oral

  • Itraconazole (Sporanox)
  • Fluconazole (Diflucan)
  • Terbinafine (Lamisil)

If you also have athlete's foot, treat it at the same time you are treating your jock itch so that both infections aren't likely to recur.

Side effects from oral medications include gastrointestinal upset, rash and abnormal liver function. Taking other medications, such as antacid therapies for ulcer disease or gastroesophageal reflux disease (GERD), may interfere with the absorption of these drugs. Oral medications for fungal infection may alter the effectiveness of warfarin, an anticoagulant drug that decreases the clotting ability of your blood.

Since the introduction of newer medicines, doctors rarely prescribe griseofulvin, another oral medication, to treat fungal skin infections. Although griseofulvin is effective, it can take longer to clear up the infection. Its most common side effect is headache, and it occasionally causes discomfort in the digestive tract, sensitivity to light, rashes or a drop in your white blood cell count. The most common use of griseofulvin is for people who are allergic to other antifungal medications, or for people who have other medical conditions that may be negatively affected, such as liver disease.

Prevention

Reduce your risk of jock itch by taking these steps:

  • Bathe daily. Shower or bathe daily and after exercising, participating in sports or sweating excessively. This helps keep the number of bacteria on your skin in check. Wash your hands often to avoid the spread of infection.
  • Stay dry. Keep your groin area dry. Dry your genital area and inner thighs thoroughly with a clean towel after showering or exercising. Use powder around your groin area to prevent excess moisture.
  • Keep clean. Change your underwear at least once a day or more often if you sweat a lot. Wash workout clothes frequently.
  • Be cool. Don't wear thick clothing for long periods of time in warm, humid weather.
  • Find the correct fit. Make sure your clothes fit correctly, especially underwear, athletic supporters and sports uniforms. Avoid tightfitting clothes, which can rub and chafe your skin, making you more susceptible to jock itch. Try wearing boxer shorts rather than briefs.
  • Don't share personal items. Don't let others use your clothing, towels or other personal items. Refrain from borrowing these items from others as well. Also make sure shared exercise machines are cleaned between uses.
  • Treat athlete's foot. Keep on top of athlete's foot to prevent its spread to the groin.

November 16, 2006

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