Jock Itch

History and Physical Exam

As the name implies, jock itch causes a burning or itching sensation in the affected areas. The region is usually large, red, and has a border that is easy to see. The affected skin may be flaky. It usually advances down the thigh, with the leading edge remaining red and scaly. The skin that has been affected longer may turn brown.

There is usually a history of the athlete remaining in sweaty clothes after workouts. Specifically, tight underwear and jockstraps allow for a warm and sweaty environment. This helps the dermatophyte to grow and cause the infection.

Diagnosis

Jock itch is usually diagnosed on clinical grounds alone, based on the location, appearance, and history of the rash. However, if there is a question, the diagnosis can be confirmed by a KOH (potassium hydroxide) test. The affected skin is scraped, allowing debris to fall onto a glass slide. Potassium hydroxide is added to the slide, and under a microscope, the examiner can see the dermatophyte.

Medication

Jock itch is almost always easily treated with topical antifungal lotions. These have minimal side [Page 734]effects. Terbinafine, clotriamazole, and ketoconazole have all been effective. The cream must be applied twice daily for up to 4 weeks to completely treat the infection and decrease recurrence.

Oral medications are saved for people who fail topical therapy or have very extensive disease. The common medications are griseofulvin, terbinafine, and fluconazole. These medications work well but often have significant side effects, such as sensitivity to sunlight, upset GI tract, rash, and headache.

Prevention

Educating athletes on proper hygiene is important. Athletes should shower with soap and water immediately following every workout. They should put on clean clothes after the shower and not the clothes they have just worked out in. They also need to be aware that skin-to-skin contact can transmit fungal infections. Athletes should not share equipment without thoroughly washing it first.