Jock itch gets worse with scratching

Dear Dr. Roach: I have been suffering for some time with jock itch. The resulting scratching leaves my groin area and thighs abraded and oftentimes bleeding. In addition to the ketoconazole I’ve been prescribed, I have tried several over-the-counter sprays and ointments, to no avail. My doctor prescribed generic Claritin (loratadine) 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.

Answer: In general, when a treatment isn’t working, the first thing to re-evaluate is whether your diagnosis is correct. Jock itch can be confused for other conditions — for example, inverse psoriasis, seborrheic dermatitis, erythrasma or a different fungal infection, Candida, among other possibilities.

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.

Dear Dr. Roach: I read your recent column on tinnitus. I am 91 years old and suffered from tinnitus for years, but as I write this I hear no noises. Ten years ago, my doctor prescribed sertraline. The pill worked for me, reducing noise by 70% at first. Sometimes the tinnitus returns for short periods, but it soon disappears. The literature provided with the pills said sertraline is for depression.

I have never been depressed in my life.

T.G.

Answer: A well-done study showed sertraline to be effective in reducing tinnitus severity.

I’m not going to rush to prescribe this drug for tinnitus. Like all drugs, it has the potential for side effects, such as diarrhea, but it may be worth trying for those whose symptoms are more severe.