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Doctor's Consultation  by Dr. Iain Corness

 

Anyone troubled with “crotch rot”?

With the hot and humid weather of late, this is the ideal growing time for Dermatophytes, and what better place to find warmth and wetness than the inguinal areas, otherwise known as one’s groin. A good crop of Dermatophytes causing an itchy rash in the area, and known colloquially as “crotch rot”. It has an even more descriptive name of “Dhobi itch” in some regions of the world.

So let’s talk about the condition. The correct name is Tinea, and we have several types depending upon the area of the body that is affected. If it is in your scalp we call it Tinea capitis; on the body - Tinea corporis; on the hands - Tinea manum; on the feet - Tinea pedis (Athlete’s Foot) and in the groin we call it Tinea cruris, otherwise known as Dhobi itch or crotch rot! What a wonderful grab bag of conditions to say the least.

The organisms which cause all these are called Dermatophytes, and they have the ability to live in skin and so can invade hair and even nails. Imagine the Dermatophytes are like cabbages planted in the garden and growing in the soil, with roots growing downwards. The most common has the exciting name of Trichophyton rubrum, a noble name for an organism that can live in the soggy bits between your toes, I’m sure you’ll agree.

In fact, a friend of mine confided the other day that he has been having a never-ending battle with Athlete’s Foot. This is one of the most common conditions in the world, and you certainly do not have to be an athlete to get it (my friend most certainly isn’t) - but it helps!

Why? Because athletes, like so many sporting groups tend to stand around shower/changing areas in their bare feet, spreading the little organism that causes the condition.

The symptoms generally consist of a spreading “rash” with reddened edges that becomes itchy and eventually quite painful as the infection goes into the deeper layers of the skin. This is the result of the organism putting out roots which extend deeper.

Unfortunately, there are a number of other conditions that can manifest themselves in a similar fashion, including psoriasis, eczema and some forms of dermatitis. This is the most usual reason for “Athletes Foot” preparations that are not working - it wasn’t “Athlete’s Foot” to begin with!

There are various methods of clinching the diagnosis, including examination with a special Wood’s Light, which allows you to look at the affected region with UV light. The most accurate way, however, is to take scrapings and examine under the microscope for the tell tale “roots”.

So what can you do if it really is our friend Trichophyton that is cropping up between your toes and other unmentionable places? The first thing to do is not to use high powered steroid creams bought over the counter, but use a topical anti-dermatophyte preparation like Canesten cream. You can alternate with a weak steroid, but remember that the steroid does not “cure” the problem - it only masks it. And if it does not settle quickly with the cream, go and see your doctor (which really should be the first option).

With some very stubborn cases it may be necessary to use medication by mouth to attack the organism through the blood stream, but these can have some fairly unpleasant and nasty side effects, especially on your liver. If your liver is already having problems straining the blood out of the beer stream then you need to use extreme caution.

To prevent re-occurrence it is necessary to be very careful where you put your toes, never share towels and jump over communal bath mats - but even then you may find it comes back. Remnants of the organism start putting out their roots and the cycle is on again. And stop scratching!

Some dermatologists also believe that you should put your socks on before you put on your jocks. This way Dermatophyton spores can’t fall off your feet and get carried up to the groin to continue their interesting work in that warm, moist area, which is just great for growing fungus. If nothing else, it’s an interesting theory.