Dear Doctor: I'm a 74-year-old male with a stubborn case of jock itch. I've tried every over-the-counter ointment, powder and soap, with no success. A prescription cream keeps it from getting worse, but it doesn't stop the problem. Do you have any other recommendations on how to treat this?

Dear Reader: Jock itch is a topical infection that can be caused by keratin-loving fungi known as dermatophytes, and by a yeast known as candida. Also known as tinea cruris, jock itch is a red, scaly and very itchy rash that appears in areas of the body that stay warm and moist. It gets its name because it's common in athletes, and also from its location in the area of the groin and inner thighs. It's more common in men than in women, and it can also arise in people who perspire freely, individuals who are overweight and people with a weakened immune system.

The battle against jock itch takes place on two fronts. One is the use of antifungal medications. This includes the drug store creams, lotions, soaps and powders that you have tried, and a small number of prescription medications. Most people do have success with over-the-counter treatments. More persistent cases of jock itch can call for a prescription for topical medications, including oxiconazole or econazole, or an oral medication, such as fluconazole or itraconazole. If you haven't had success with topicals, ask your health care provider if an oral treatment might be the next step.

It's important to understand that medications are only a start. Just as important is eliminating the environment that allows fungi to flourish. That means a thorough and sustained campaign to keep the affected areas very clean and very dry. And by sustained, we mean remaining vigilant from now on. Meds can ease a fungal infection in the short term, but you now know you're susceptible to this type of condition. That means keeping the affected areas clean and dry will become part of your daily routine. If not, recurrences of the condition are likely.

We recommend that our patients who are dealing with jock itch also use a barrier method, like Butt Paste or Desitin, which are zinc oxide-based creams. Something else that has proved effective, particularly in humid climates where getting completely dry is a challenge, is using a blow dryer. Put it on the lowest heat setting so you don't risk burning yourself, and use it to remove all residual moisture. That, along with the barrier cream, will eliminate the environment that fungi crave. You'll also want to start wearing loose-fitting clothing, including underwear, to allow maximum air flow. And be vigilant about washing your hands, which can transfer the fungi. Also, be aware that it can take a month, or even longer, to vanquish a case of jock itch.

If your condition persists despite meds and proper hygiene, you may not actually have jock itch. Other conditions, such as lichens planus, can present with similar symptoms. We recommend that you seek out a board-certified dermatologist to make sure you've received an accurate diagnosis.

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