Tinea kruris is superficial mycosis or also called Eczema marginatum, Dobie itch, Jockey itch,

Ringworm of the groin, which belongs to the group of dermatophytosis in the groin, perineal
area, and around the anus. This disorder can be acute or chronic, it can even be a disease that
lasts a lifetime. Tinea kruris is superficial mycosis or also called Eczema marginatum, Dobie itch,
Jockey itch, Ringworm of the groin.15 which belongs to the group of dermatophytosis in the
groin, perineal area, and around the anus. This disorder can be acute or chronic, it can even be
a disease that lasts a lifetime.
Tinea cruris is dermatophytosis in the thighs, genitalia, pubic region, perineum and perianal.
Trichophyton rubrum (T. Rubrum) is the main cause, followed by Trichophyton mentagrophytes
and Epidermophyton floccosum (E. Floccosum).
Trichophyton rubrum, Trichophyton mentagrophytes and Epidermophyon floccosum are
dermatophytes that like warm and moist areas of intertriginous and occlusive skin like thigh
interrupts.
Skin disorders that appear between the thighs are well-defined lesions. Inflammation on the
edges is more pronounced than the middle part. Eflorescence consists of various forms of
primary and secondary (polymorphy). If the disease becomes chronic, it can be a black spot
with a few scales. Erosion and discharge are usually due to scratching

Epidemiology
Tinea cruris can be found throughout the world and most in the tropics. The incidence is more
common in adults, especially men than women. This fungus often occurs in people who pay less
attention to cleanliness or dirty and humid surroundings.
In Indonesia, dermatophytosis is 52% of all dermatomycosis and tinea cruris and tinea corporis
is the most dermatophytosis. The incidence of dermatomycosis in various medical teaching
hospitals in Indonesia which shows the percentage of all cases of dermatophytosis varies from
2.93% (Semarang) to the lowest to 27 , 6% (Padang) the highest. Men after puberty are more
affected than women, usually regarding ages 18-25 years and 40-50 years.

Etiology
The main causes of tinea cruris are Epidermophyton floccosum and Trichophyton rubrum. In
addition it can also be caused by Trichophyton mentagrophytes and although it is rarely caused
by microsporum gallinae.

Factors that influence the occurrence of tinea cruris

The factors that influence the occurrence of this fungal infection are hot, humid climate,
sanitary hygiene, nylon clothing, excessive sweating, skin trauma, and the environment.
Maseration and occlusiveness in the cruric region contributes to the condition of moisture
which causes the development of fungal infections. Tinea cruris is highly contagious and minor
epidemics can occur in schools and other similar communities. Tinea cruris generally results
from other dermatophytosis infections in the same individual through direct contact with the
patient such as shaking hands, sleeping together, and sexual intercourse. But it can also be
through indirect contact. through contaminated objects, "clothes, towels, bed linen, pillows,
etc.".
Pathogenesis

Tinea kruris usually occurs after contact with an infected individual or animal. Spread may also
occur through objects such as clothing, furniture, and so on. Tinea kruris generally occurs in
men. Maseration and occlusion of the groin skin increases the temperature and humidity of the
skin, making it easier for infection, but it can also occur due to the spread of infection from
other body parts. Dermatophytes have an incubation period of 4-10 days. Dermatophyte
infections involve three main steps: attachment to keratinocytes, penetration through and
between cells, and development of host responses.

a. The attachment of the superficial fungus must pass through various obstacles to be attached
to the keratin tissue including UV light, temperature, humidity, competition with normal flora
and sphingosin produced by keratinocytes. Fatty acids produced by the sebaceous glands are
also fungistatic.
b. Penetration. After attachment, the spores must develop and penetrate the stratum corneum
at a speed faster than the desquamation process. Penetration is also aided by the secretion of
proteinases, lipases and mucinolytic enzymes, which also provide nutrients for fungi. Trauma
and maceration also help fungal penetration into keratinocytes. A new defense arises when the
fungus reaches the deepest layer of the epidermis.
c. Development of host response. The degree of inflammation is influenced by the immune
status of the patient and the organisms involved. Type IV hypersensitivity reactions, or Delayed
Type Hypersensitivity (DHT) play a very important role in fighting dermatophytes. Patients who
have never been infected with a dermatophyte before, Primary infection causes inflammation
and the trichopitin test results are negative. The infection produces a small amount of
erythema and squamous resulting from an increase in changes in keratinocytes. There is a
hypothesis that the dermatophyte antigen is processed by Langerhans epidermal cells and is
expressed in T lymphocytes in the lymph nodes. T lymphocytes proliferate and migrate to the
infected site to attack the fungus. At present, the lesion suddenly becomes inflamed, and the
epidermal barrier becomes permeable to transferrin and migrating cells. Immediately the
fungus disappears and the lesion spontaneously heals

Clinical features
Patients feel itchy and abnormalities of lesions in the form of a firm bounded placard consist of
various skin efflorescence (polymorphic). This diverse form of lesion can be a little
hyperpigmentation and a chronic squeeze. The abnormalities seen in the clinic are round or
oval lesions, well-defined, consisting of erythema, squamous, sometimes with vesicles and
papules on the edge of the lesion. The area in the center is usually quieter, while the one at the
edge is more active which is often called central healing. Sometimes erosion and crusting are
seen due to scratching. Skin disorders can also be seen polycyclic, because some skin lesions
become one. Lesions can expand and provide a picture that is not typical especially in
immunodeficient patients.

Diagnosis
The diagnosis is based on clinical features, namely the presence of skin abnormalities in the
form of well-defined lesions and inflammation where the edges are more pronounced than the
middle part. Mycological examination found fungal elements in microscopic examination of skin
scrapings directly using 10-20% KOH solution. KOH examination is most easily obtained by
sampling from the lesion boundary. The positive 10% KOH microscopic examination results,
namely the presence of fungal elements in the form of branching and or arthrospores.
Mycological examination to get mushrooms requires clinical ingredients, which can be
scrapings of skin, hair, and nails.

Differential diagnosis
a. Seborrheic dermatitis
Chronic dermatitis that occurs in areas that have a lot of sebaceous learning. As in the face,
head, chest. Eflorescence: Erythematous plaques with oily yellowish squares with firm
boundaries.
b. Psoriasis
Is a chronic, residual, and non-infectious skin disease. Eflorescence: erythematous plaques with
firm borders covered in thick, multi-layered and shiny white. There are three phenomena,
namely when scratched with a blunt object showing the droplets of wax. Then if the squash is
peeled one by one until the base will appear bleeding spots, known as the Auspits sign. The
existence of a koebner phenomenon / or isomorphic reaction is the occurrence of the same
lesions with abnormalities of psoriasis due to trauma marks / scratching.
c. Pyiriasis rosea
It is an acute skin inflammation in the form of papuloskuamosa lesions on the body, proximal
upper arms and upper thighs. Eflorescence: oval-shaped papules / erythematous plaques with
collarette squares (smooth squares on the edges). The first patch (Mother patch / Herald patch)
is a large, solitary, ovarian and anular spot with a diameter of two to six cm. Lesions are
arranged according to the folds of the skin so as to give an image resembling a pine tree
(Christmas tree).

Management
Management of tinea cruris can be divided into two: hygiene sanitation and pharmacological
therapy. Through hygiene sanitation, tinea cruris can be avoided by preventing risk factors such
as used underwear, it can absorb sweat and be replaced every day. Groin or groin area must be
clean and dry. Avoid wearing narrow and tight pants, especially those that are used for a long
time. Keeping the groin area or groin dry and not moist is one of the factors that prevent
infection in tinea cruris.
Nowadays, Dermatophytis in general can be overcome by giving fungistatic griseofulvin. The
griseofulvin treatment dosage chart is different. In general, griseofulvin in the fineparticle form
can be given with a dose of 0.5-1 g for adults and 0.25-0.5 g for children a day or 10-25 mg per
kg body weight. Duration of treatment depends on the location of the disease and the
condition of the patient's immunity.
Side effects of griseofulvin are rarely encountered, which is a major complaint is cephalgia
found in 15% of patients. Other side effects can be digestive tract disorders such as nausea,
vomitus, and diarrhea. The drug is also photosensitive and can interfere with liver function.
a. Topical: antimicotic ointment or cream. The location of this location is very sensitive, so the
drug concentration must be lower than other locations, such as salicylic acid, benzoic acid,
sulfur and so on.
b. Systemic: given if the lesion is widespread and chronic; griseofulvin 500-1,000 mg for 2-3
weeks or ketoconazole100 mg / day for 1 month.

Complications
Tinea cruris can be secondary to other candida or bacteria. In chronic fungal infections
lichenification and skin hyperpigmentation can occur.

Prognosis
The prognosis of this disease is good with the right diagnosis and therapy as long as the
moisture and cleanliness of the skin are always maintained

1. Referensi : Janik, M. P., &Heffernan, M. P. Superficial Fungal Infection :

Dermathopytosis, Onycomycosis, Tinea nigra, Piedra . In: Fitzpatrick Dermatology in
General Medicine. McGraw-Hill: USA. 2008. p 1807-1822.