Resistant cases of tinea cruris

Tinea cruris is a fungal infection of groins. This usually occurs commonly in males. It is known as Dhobie’s itch or Jock itch. The causative agents are dermatophytes-fungus like T rubrum and E floccosum. Transmission is through direct contact between infected people or indirect transmission through fomites. According to Dr Shibu Mohammed, a well-known dermatologist in Muscat, the infection mainly happens in warm, humid climate. Clinical feature of skin in groins will be well-marginated raised border composed of multiple erythematous papulo-vesicles and a clear centre (like a red ring). Lesions are seen on the genito-crural area and on the medial aspect of thighs. They spread to involve buttocks, lower back and abdomen. Spread to scrotum is common. Itching is a predominant feature. Chronic scratching may lead to lichenification. Secondary infection may supervene. Weeping and maceration and areas of pustulation may occur. Treatment modalities by dermatologists are tropical anti-fungal for four weeks and finally systemic anti-fungals. But what happens here is patients will directly go to pharmacy or doctors and complain of his itching problem without showing the lesions and most of them give steroid creams. Here we cannot blame the pharmacists or doctors. Most of the patients feel shy to show the lesions. Tinea infection get modified and the patient is often initially satisfied. Itching is controlled and inflammatory signs settle, but there is relapse on stopping the treatment. Patient again reapplies the steroid cream and get addicted to steroid creams application. After a few months, raised margin is diminished, scaling is lost and the inflammation is reduced to nondescript nodules . Often a bruise like brownish discolouration is seen, especially in the groins. Chronic use causes atrophy (thinning of skin), telangiectasia (dilated skin blood vessels) and striae in the groins. According to Dr Shibu, retreating those patients with anti-fungal creams do not show benefits now-a-days and resistant Tinea infections are common. Steroid creams are indicated in eczema and psoriasis and other various skin disorders which only under dermatologists supervision given to patients”, he adds.