Diseases

Jock itch does not affect the entire body. It is usually limited to the groin, inner thigh folds, genitals, and anal area. Itching (pruritus) of the entire body is not typical of jock itch.

The diagnosis of jock itch is usually based on the symptoms and skin appearance. A microscopic examination of skin scrapings covered in a drop of potassium hydroxide will confirm a fungal cause of jock itch. Occasionally, a fungal culture of the skin scrapings may be necessary. Certain bacteria can produce an eruption in the groin indistinguishable from a fungal infection. An examination with a special ultraviolet light, a Wood's light, will enable identification.Occasionally, a small skin biopsy may be used to help the doctor confirm the diagnosis. Rarely, a skin biopsy (surgically taking a small piece of skin using local numbing medicine) that is examined under a microscope may be necessary in atypical or widespread cases. Sometimes skin biopsies help to exclude other possible diagnoses. A skin swab or culture may be taken and sent to the lab to detect an infectious cause of the jock itch. A bacterial culture may be useful to detect bacteria, such as Staphylococcus.

Mild bacterial jock itch may be treated with

• antibacterial skin washes like Lever 2000 soap and a neomycin-containing ointment.

Moderate bacterial jock itch may be treated with

• antibacterial skin washes like chlorhexidine soap twice daily; and
• twice-daily application of a topical antibiotic like erythromycin lotion or metronidazole (Flagyl) lotion.

Severe bacterial jock itch may be treated with

• antibacterial skin washes like chlorhexidine soap twice daily;
• twice-daily application of a topical antibiotic like clindamycin lotion or metronidazole lotion; and
• a five- to 14-day course of an oral antibiotic like cephalexin (Keflex), dicloxacillin, doxycycline, minocycline (Dynacin, Minocin), or erythromycin.

Mild fungal or yeast jock itch may be treated by

• washing the groin twice daily with an antifungal shampoo like ketoconazole (Nizoral shampoo) or selenium sulfide (Selsun Blue shampoo).

Moderate fungal or yeast jock itch is often treated by a combination of

• washing the groin twice daily with an antifungal shampoo like ketoconazole or selenium sulfide; and
• using a topical antifungal cream like miconazole (Monistat, Micatin), clotrimazole (Lotrimin, Mycelex), or terbinafine (Lamisil).

Severe fungal or yeast jock itch is typically treated by a combination of

• washing groin twice daily with an antifungal shampoo like ketoconazole or selenium sulfide;
• using a topical antifungal cream like miconazole, clotrimazole, or terbinafine; and
• taking an antifungal pill like fluconazole (Diflucan), itraconazole (Sporanox), or terbinafine.

Assuming the condition is not caused by an infectious agent, itching from jock itch can be treated with a short course of one of the following:

• Use a short five- to seven-day course of a mild to medium potency, topical steroid cream like prescription triamcinolone 0.025% once or twice a day for inflamed or itchy areas.
• Use a short five- to seven-day course of a mild over-the-counter topical steroid cream like 1% hydrocortisone (Cortaid) one to three times a day for itching.

Jock itch prevention efforts include good general skin hygiene and keeping the groin clean and dry. The following preventive steps will help:

• Wash groin and buttocks with soap and water after exercise and sweating.
• Wash workout clothes, underwear, and swimwear after each use.
• Minimize groin moisture by using white cotton underwear.
• Change underwear frequently and especially after sweating.
• It may be useful to apply petroleum jelly or zinc oxide ointment (Desitin) liberally to the groin creases prior to physical exercise to minimize friction skin damage.
• Wash clothes, undergarments, and towels in hot soapy water.
• Use loose-fitting cotton underwear and clothing.
• Avoid undergarments with polyesters, nylon, or synthetic fibers.
• Use an antifungal powder like Lamisil or Zeasorb to keep the groin dry.
• Avoid perfumed creams, powders, sprays, or lotions on the groin.
• Do not go barefoot, especially at gyms, schools, and public pools.
• Treat athlete's foot if you have it.
• Cover your feet with socks before you put on your underwear and pants.

Most cases of jock itch are easily and fully curable. There are very uncommon, long-standing cases of jock itch that may not be cured. Often these more resistant cases may be controlled with proper treatment and medication. Jock itch sometimes clears completely by itself without treatment.Although most cases of jock itch are not contagious, cases caused by an infection may be transmitted through skin or sexual contact, sharing of swimwear, or towels. It is possible to transmit fungal jock itch to someone else through close skin contact.Some people are simply more prone to developing jock itch because of their overall health, activity, anatomy, possible altered immune status, exposure history, and other predisposing skin conditions like eczema. People with athlete's foot (tinea pedis) are more prone to developing jock itch.

Jock itch usually begins with mild intermittent itching in the groin. The itching can get worse and become unbearable in some cases. The rash is usually on both sides of the groin and affects the folds.The rash may become dry, rough, and bumpy, develop pus blisters, or begin to ooze. Sometimes, there is central clearing as the redness of the rash spreads outward to the thighs. The itching and rash can spread to the genitals, including the labia, vagina, scrotum, penis, and anus.Women may also develop vaginal white discharge and yeast infections. Men may develop infections on the head of the penis, especially if they are not circumcised.Severe cases may be very uncomfortable and develop secondary complications such as breaks in the skin, open sores, ulcers, and rarely cellulitis.

Complications are infrequent since jock itch is usually a self-limited skin condition. Rarely, the rash may spread past the groin onto the thighs and genitals. Secondary skin infections from scratching or rubbing can uncommonly deepen, causing cellulitis or abscess formation.Another potential complication includes temporary skin discoloration called post-inflammatory hypopigmentation (lighter than the regular skin color) or hyperpigmentation (darker then the regular skin color). This altered skin color may occur after the rash has improved or after a temporary flare. Permanent scarring is uncommon.

Jock itch is most common in adult and middle-aged men. Anyone can get jock itch, which is thought to affect nearly all people at some point in their lives.Certain groups of people may be more prone to jock itch. Patients with diabetes, obesity, and those with a compromised immune system such as from HIV/AIDS, hepatitis, chronic illnesses, cancer, systemic chemotherapy, immunosuppressive drugs such as prednisone, and those on biologic immune-system-modifying drugs such as infliximab (Remicade) or etanercept (Enbrel) may be more prone to jock itch.Other risk factors include

• male genitalia,
• heat,
• moisture,
• humidity,
• obesity,
• excess sweating,
• exercise,
• weakened immune system,
• tight, occlusive fabrics and undergarments, and
• athlete's foot infection or other fungal infections on the body.

Causes of jock itch include the following:

• Warmth, skin friction, and moist areas in the groin
• Tight, occlusive clothing and undergarments that trap in sweat
• Infections caused by fungus and yeasts: Candida (yeast), Trichophyton, and Epidermophyton (fungal molds)
• Infections by certain types of bacteria

Generally, diet does not seem to affect jock itch.

Holistic (nonmedicated) home remedy options for jock itch include

• soaking the affected area daily with a washcloth dipped in dilute white vinegar (1 part vinegar to 4 parts of water) and drying the skin; and
• soaking in a bathtub daily or every other day with very dilute Clorox bleach (1 quarter cup of Clorox bleach in a bathtub full of water) and drying the skin.

Home remedy for mild jock itch includes the following:

• Wash the groin skin two to three times a day.
• Keep the groin area dry.
• Avoid excess groin skin irritation by wearing 100% cotton underwear.
• Avoid fabric softeners, bleaches, or harsh laundry detergents.
• Apply a mix of over-the-counter hydrocortisone cream and clotrimazole (Lotrimin, Mycelex) cream one to two times a day to the affected area and covering this liberally with zinc oxide ointment.

Jock itch is a common, itchy rash of the groin. It can produce a very intense itch and is associated with a red or pink rash involving the groin folds and genitals. Jock itch is primarily a skin condition in men because of anatomic structures unique to males, the male genitalia.The symptoms and signs of jock itch may come and go, and many cases of jock itch resolve spontaneously without any treatment. Jock itch is primarily seen in the groin, although it may spread to the inner thighs, genitals (including penis, scrotum, labia, and vaginal opening), and anus. Jock itch causes a red or pink rash on the sides of the groin folds. There may be a dry, scaly, well-demarcated rash or a collection of small, pinpoint red or pink bumps at each hair follicle. This form of eruption is often called ringworm because of its well-defined red edge with central clearing. The medical term for ringworm of the groin is tinea cruris, and it is caused by a fungal infection.While jock itch is frequently noted in otherwise healthy people, those with diabetes and/or obesity are more susceptible. Possible causes include irritation from tight or abrasive underwear, excess moisture, sweating, skin rubbing or friction, allergic problems, fungal infection, Candida (yeast) infection, and bacterial overgrowth.Treatment of fungal-related jock itch may include one or a combination of antifungal creams and, rarely, antifungal pills. Treatment of jock itch that is not caused by fungus involves proper groin hygiene, keeping the area clean and dry, and washing frequently with gentle soap and water (especially after sweating or exercise).

Overall, the best jock-itch drug is a topical antifungal cream like miconazole, clotrimazole, or terbinafine, assuming the condition is produced by a fungus. If the jock itch does not improve within two to three weeks of treatment, then a physician should be consulted. The use of the topical antifungal should be suspended for two weeks prior to seeing the physician.

The prognosis with jock itch is very good. Overall, jock itch tends to be an easily treated and curable skin condition. Commonly, it is a mild, benign, usually noncontagious, and self-limited skin condition. More widespread, atypical cases of jock itch may be embarrassing, chronically disfiguring, and psychologically distressing.

There are many treatment options and skin care recipes for treating jock itch. Since the two primary causes of jock itch are excess moisture and fungal infections, treatment depends on the exact cause of the jock itch. Treatment of jock itch associated with skin irritation and excess moisture should address general measures to keep the groin clean and dry along with the use of zinc oxide ointment. Treatment of fungal jock itch should include antifungal creams used continuously for two to four weeks. Clotrimazole cream is an effective treatment for both dermatophyte molds and Candida (yeast) and can be purchased without a prescription.It is important to keep in mind that no therapy is uniformly effective in all people.

If jock itch persists over one to two weeks despite proper skin care and use of over-the-counter medications, it may be necessary to schedule an appointment to see a physician. In addition, if the rash is worsening despite medical treatment or if any of the following signs of an advancing skin infection develop, contact a physician.

• Spreading despite treatment
• Increasing pain
• Rapidly spreading rash
• Formation of pus, abscesses, or draining sores
• Red streak(s) extending from the groin (called lymphangitis)
• Fever or chills
• Failing to improve after two weeks of continuous topical treatment

Most primary care physicians can accurately diagnose and treat jock itch. A few other medical conditions may appear just like jock itch and should be examined more closely by a dermatologist.Other medical conditions can mimic jock itch. Some possible mimics include

• ringworm, also called tinea,
• contact dermatitis,
• intertrigo,
• erythrasma,
• impetigo,
• diaper rash,
• irritant or contact dermatitis,
• heat rash,
• familial pemphigus, and
• inverse psoriasis.

Jock itch may be associated with athlete's foot, also called tinea pedis. The same fungus that causes athlete's foot in a person may actually spread to the groin in some cases. It is important to always check the feet for rashes in people with jock itch. Spread of the fungus usually occurs when fungal particles pass onto the crotch while putting on underwear. Any foot infection must be treated in order to avoid recurrence of the jock itch.

Residual skin discoloration in the groin may persist for weeks to months after more severe forms of jock itch clear. Because it is in an area that is not generally visible, it does not usually require treatment. Eventually, the skin discoloration will return to a more natural color.