Jock itch is common in men who sweat a lot. Jock itch symptoms arise from a fungal infection with an itchy rash in the groin.

Jock Itch

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PNS SHIFA

Syed Intisar Hussain

Jock itch, also known as tinea cruris, is a fungal infection involving the groin and inner thighs. In Latin, &lsquo;tinea&rsquo; translates to ringworm and &lsquo;cruris&rsquo; denotes groin. Thus, tinea cruris refers to the ringworm of the groin.5,7 
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Overview

Tinea, or ringworm, is the name given to fungal skin and nail infections. Dermatophytes belonging to three subcategories, Microsporum, Trichophyton, and Epidermophyton are responsible for causing tinea infections. Warm, moist environments can lead to an overgrowth of these dermatophytes within the skin, hair, and nails, causing an infection.

Approximately, 20 to 25% of the world&rsquo;s population is affected by superficial fungal infection.8 It is most common in hot, humid regions. Moreover, adult males are most commonly affected.

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Ringworms are classified based on the part of the body they infect. For example, tinea capitis refers to the ringworm of the scalp, tinea pedis is the ringworm of the foot (athlete&rsquo;s foot), and so on.

Tinea cruris is characterized by a red, ring-shaped rash that mostly appears in the areas around the groin. Trichophyton rubrum is the most common cause of tinea cruris worldwide.1 It is named jock itch because the infection is frequent among athletes.

Tinea cruris is not a serious condition and has cure rates ranging from 80 to 90%.1&nbsp;However, recurrence is common due to autoinfection. 
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There are no subtypes of jock itch. 
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Signs and Symptoms

The fungal infection typically begins as a red, flat, itchy rash on the inner thighs. As it spreads, the center clears and the rash develops a ringlike circular pattern. The borders of the rash are red and may also have bumps or blisters. 
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Other common signs and symptoms of jock itch include:

<ol>
	<li>Burning sensation</li>
	<li>Redness</li>
	<li>Itching</li>
	<li>Changes in the color of the skin of the affected area</li>
	<li>Flaky, cracking, or peeling skin</li>
	<li>The rash does not respond to hydrocortisone</li>
	<li>The rash worsens with exercise 
	&nbsp;</li>
</ol>

Although the groin and inner thighs are mostly affected, the rash can also spread to the buttocks and abdomen. However, the scrotum is spared. Moreover, in women, the armpits and breasts can also be affected. 
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Causes

Jock itch, or tinea cruris, results from an infection with dermatophytes. Although these fungi are naturally part of the skin&rsquo;s flora, certain factors can lead to overgrowth, causing an infection. Tight garments trap moisture and heat, creating a warm and humid environment for the fungi and helping them multiply and spread. Therefore, athletes are most prone to developing jock itch. 
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Moreover, the fungal infection is highly contagious, easily spreading via skin-to-skin contact or fomites. Sexual intercourse with an infected person can also result in a jock itch. Contact with infected clothing, towels, or objects causes it to easily spread from person to person.

Tinea pedis is also a common cause of jock itch. People can easily spread the fungus by touching the groin after contact with the infected foot. Touching the waistband of your undergarment with infected hands can also spread the infection. 
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Once the causative agent targets your body, it produces keratinases. These keratinases destroy the cornified epithelium cell layer, destroying the affected skin. The level of skin destruction depends on the immune system of the host. A stronger host immune system leads to lesser skin destruction by the causative agent.&nbsp; 
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There are essentially no screening tests available for jock itch. 
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Diagnosis

A patient&rsquo;s clinical presentation is often enough to diagnose a jock itch. However, at times, doctors may order several tests to rule out other causes of rash in the groin, such as seborrheic dermatitis, yeast infection, and psoriasis. 
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The following tests can help diagnose jock itch:

<ul>
	<li>KOH Exam - The margin of the lesion is scraped and added to a glass side. Next, a few drops of potassium hydroxide (KOH) are added and the sample is viewed under the microscope for the presence of fungi. The KOH helps dissolve the skin cells, leaving behind fungal cells.</li>
	<li>Skin Biopsy With Periodic Acid-Schiff (PAS) Stain - Fungal elements in the sample appear pink.</li>
	<li>Skin Culture Exam 
	&nbsp;</li>
</ul>
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Treatment

Tinea cruris is easily treated using over-the-counter (OTC) antifungal ointments, sprays, or powder. However, if the OTC medications are ineffective, doctors may prescribe topical (e.g., econazole, oxiconazole, clotrimazole) or oral medications (e.g., fluconazole, itraconazole, terbinafine). It is important to complete the whole course of medication to prevent a recurrence. 
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Other measures to take when treating the jock itch include:

<ul>
	<li>Keep the affected skin dry to prevent entrapping of moisture</li>
	<li>Keep the area clean to prevent a recurrence</li>
	<li>Avoid scratching the groin</li>
	<li>Treat any other fungal infections, such as tenia pedis 
	&nbsp;</li>
</ul>

NOTE: If the symptoms persist despite 2 weeks of treatment or worsen, contact a healthcare professional as you may have developed a secondary infection. 
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There are hardly any complications of jock itch, but sometimes the following can occur: 
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<ul>
	<li>The rash may spread to the buttocks, thighs, and genitals</li>
	<li>Temporary discoloration of the skin</li>
	<li>Secondary bacterial or candidal infections, such as cellulitis or the formation of an abscess</li>
	<li>Recurrence due to autoinfection 
	&nbsp;</li>
</ul>
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The following factors increase the risk of jock itch:

<ul>
	<li>Gender - Men are more at risk than females.</li>
	<li>Highly Active Sweat Glands - Excessive sweating provides a suitable environment for the growth of fungus.</li>
	<li><a href="https://merisehat.pk/disease/diabetes-type-1-and-2">Diabetes </a>- Diabetic people are at twice the risk of developing tinea cruris. The high sugar content in their sweat provides the fungus with a nutrient-rich environment. Their weakened immune system also plays a role in the development of common diseases. Moreover, since diabetic patients are often obese, it increases their risk further.</li>
	<li>Tight Clothing - Tight undergarments trap moisture, providing fungi with a favorable environment for growth.</li>
	<li><a href="https://merisehat.pk/disease/obesity">Obesity </a>- Overweight or obese people have more skinfolds that retain moisture for longer. Thus, favoring fungal growth.</li>
	<li>Poor Immune System - Diseases, such as <a href="https://merisehat.pk/disease/hiv-61">HIV </a>or cancer, and immunosuppressives or steroidal drugs increase a person&#39;s susceptibility to fungal and bacterial infections.</li>
	<li>Young Age - Teenagers are more at risk to develop fungal infections. 
	&nbsp;</li>
</ul>

A strong immune system is highly effective at keeping fungal infections away at bay. Therefore, adopting a healthy lifestyle can help reduce the risk of fungal infections. The following additional practices can help reduce the risk of jock itch: 
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<ol>
	<li>&nbsp;Clean your body properly</li>
	<li>&nbsp;Wear loose and airy undergarments</li>
	<li>&nbsp;Shower after exercise</li>
	<li>&nbsp;Use clean exercising equipment</li>
	<li>&nbsp;Avoid sharing towels and clothes</li>
	<li>&nbsp;Properly clean your towels</li>
	<li>&nbsp;Completely dry your body, especially the groin&nbsp; area, after showering or swimming</li>
	<li>&nbsp;Wear sandals in public showers, saunas, and&nbsp; at the swimming pool</li>
	<li>&nbsp;Wear socks before putting on underwear to&nbsp; prevent spreading any foot fungus to the groin</li>
	<li>&nbsp;Avoid sexual contact until the rash is healed 
	&nbsp;</li>
</ol>
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Key Points

<ul>
	<li>Jock itch is a fungal infection that affects the groin and inner thighs.</li>
	<li>Also called tinea cruris, the fungal infection is caused by dermatophytes. These fungi are part of the skin&rsquo;s natural flora, but moist, warm environments can lead them to multiply and spread.</li>
	<li>Trichophyton rubrum, a type of dermatophyte, is the most common cause of tinea cruris.</li>
	<li>The fungal infection appears as a red, itchy, ring-like lesion. Moreover, the borders of the rash often develop small blisters.</li>
	<li>Tight undergarments provide a favorable environment for the growth of fungi by trapping moisture.</li>
	<li>Athletes are most prone to developing jock itch. However, diabetes, obesity, and a weakened immune system also increase one&rsquo;s risk of infection.</li>
	<li>Sexual contact with an infected person, and sharing contaminated towels or clothes are common causes of the fungus spreading from person to person.</li>
	<li>Jock itch is diagnosed based on the person&rsquo;s clinical presentation. However, doctors may also order a KOH test or skin biopsy in some cases.</li>
	<li>Over-the-counter antifungal creams, gels, and powders are effective at treating jock itch. However, often at times, doctors may prescribe oral antifungals.</li>
	<li>Although complications are rare, recurrence is common due to autoinfection.</li>
	<li>There are various treatment options for curing the jock itch. These include antifungal creams, over-the-counter creams, gels, ointments, and sprays. 
	&nbsp;</li>
</ul>
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[1] Pippin MM, Madden ML, Das M. Tinea Cruris. [Updated 2022 Jun 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.

[2] Jock itch. Mayo Clinic. Published March 4, 2020. Accessed January 25, 2023.

[3] Nall R. What do you need to know about jock itch? Healthline. Accessed January 25, 2023.

[4] Jock itch: Causes, treatments, and remedies. Medical News Today. Accessed January 25, 2023.

[5] Jock itch: What it is, symptoms & treatment. Cleveland Clinic. Accessed January 25, 2023.

[6] Jock itch (tinea cruris). Harvard Health. Published December 29, 2021. Accessed January 25, 2023.

[7] Kean B, Bennington-Castro J, Migala J, et al. What is Jock Itch? symptoms, causes, diagnosis, treatment, and prevention. Accessed January 25, 2023.

[8] Sahoo, A. K., & Mahajan, R. (2016). Management of tinea corporis, tinea cruris, and tinea pedis: A comprehensive review. Indian dermatology online journal, 7(2), 77–86.