## Tinea Cruris — Clinical Features & Management ### Correct Statements (Options 0, 1, 2) **Key Point:** Tinea cruris is a dermatophyte infection of the groin and inner thighs, most commonly caused by *Trichophyton rubrum* in India, followed by *T. mentagrophytes*. **High-Yield:** The scrotum and labia majora are typically **spared** in tinea cruris because the dermatophyte cannot tolerate the moisture and maceration of these intertriginous areas — this is a classic distinguishing feature from candidiasis, which involves these sites. **Clinical Pearl:** Predisposing factors include: - Warm, humid climate (tropical India) - Occlusion (tight clothing, obesity) - Poor hygiene - Hyperhidrosis - Immunosuppression ### Why Option 3 is INCORRECT **Warning:** Systemic antifungal therapy is **NOT** first-line for tinea cruris. Tinea cruris is a superficial dermatophyte infection confined to the stratum corneum and can be managed with topical agents. **High-Yield:** First-line treatment is **topical antifungal** (azoles, allylamines, or terbinafine cream) applied for 2–4 weeks. Systemic therapy (e.g., terbinafine 250 mg daily for 2–4 weeks, or itraconazole 200 mg daily for 1 week) is reserved for: - Extensive or refractory lesions - Involvement of nails or hair (tinea corporis with severe inflammation) - Immunocompromised patients - Failure of topical therapy ### Site-Specific Variant Summary | Feature | Tinea Cruris | | --- | --- | | **Common sites** | Groin, inner thighs, inguinal folds | | **Spared sites** | Scrotum, labia majora (unlike candidiasis) | | **Most common organism** | *T. rubrum* (>70% in India) | | **Predisposing factors** | Moisture, occlusion, warm climate | | **First-line treatment** | Topical azole or allylamines | | **Duration** | 2–4 weeks topical | [cite:Park 26e Ch 16]
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