Jock itch not responding to the usual cures

Dear Dr. Roach: I have been suffering with jock itch. The scratching leaves my groin and thighs abraded and bleeding. In addition to the ketoconazole I’ve been prescribed, I have tried several over-thecounter sprays and ointments, to no avail. My doctor prescribed generic Claritin and I use a cortisone cream to reduce the itching, but these effect no cure. Is there any advice that you can offer to help me? — T.B.

Dear T.B.: In general, when a treatment isn’t working, the first thing to re-evaluate is whether your diagnosis is correct. Jock itch is a fungal infection caused by tinea cruris, but it can be confused for other conditions — for example, inverse psoriasis, seborrheic dermatitis, erythrasma or a different fungal infection, Candida, among other possibilities. I would consider doing a diagnostic laboratory test, such as a fungal preparation, or refer you to a dermatologist.

However, if the diagnosis is correct, it sounds like the scratching may be a big part of the problem. Constant scratching can worsen itching and lead to bacterial infection. Stopping scratching is critical, but steroid cream (cortisone) can sometimes make treatment of the underlying fungus less effective. Topical antihistamines and a pair of cotton gloves at night can help.

Resistance to ketoconazole is possible, so you could try a different type of antifungal cream. Occasionally, people need an oral medication like terbinafine or fluconazole to treat this. I would not consider oral medicines unless the diagnosis was certain and if no topical treatments were working. Oral antifungal medicines can rarely cause liver damage.