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Chapter 252: Skin Disorders: Groin and Skinfolds

Alexandra E. Zeitany; Diana B. McShane; Dean S. Morrell

INTRODUCTION

Content Update October 2021

2021 CDC guidelines for Scabies and Pediculosis Pubis. See Table 252-1 and related text. (Centers for Disease Control and Prevention, Sexually Transmitted Treatment Guidelines, July 22, 2021.)

The skinfolds of the body include the groin, intergluteal cleft, axilla, inframammary, and pannus regions. Although many skin diseases can affect the skinfolds to some degree, this chapter focuses on the most common skinfold eruptions (Table 252-1). Sexually transmitted infections are discussed in Chapter 153, “Sexually Transmitted Infections”. Molluscum contagiosum is discussed in Chapter 251, “Skin Disorders: Trunk”.

TABLE 252-1Clinical Features and Treatment of Common Disorders of Groin and Skinfolds
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TABLE 252-1 Clinical Features and Treatment of Common Disorders of Groin and Skinfolds
Condition Clinical Features Treatment Comments
Tinea cruris Symmetric, annular, erythematous, scaly plaques Topical antifungals for 1–6 wk Permanent cure is rare, patients require periodic re-treatment
Candidiasis Well-demarcated erythema and maceration with satellite pustules involving the skinfolds Topical antifungals; oral fluconazole if recalcitrant and/or recent oral antibiotics Predisposing factors including obesity and endocrine disease such as diabetes or Cushing’s syndrome
Scabies

Widespread, highly pruritic, erythematous papules; other common locations: intergluteal cleft, digital web spaces, axilla, waistband

Look closely for burrows: fine, thread-like lines with a terminal black speck

Permethrin 5% cream (safe in pediatric patients older than 2 months) and apply from beck down, wash after 12 h

Machine wash and machine dry any clothing, linens, or towels that were worn in 3 days prior to treatment

Or

Ivermectin 1% lotion applied from neck down, rinse after 12 h

Or

Consider oral ivermectin for immunocompromised

patients or refractory cases 200 micrograms/kg PO repeated in 14 d do not use in pregnant or lactating mothers or children <15 kg

 A negative scabies prep does not rule out this diagnosis; immunocompetent hosts typically harbor less than 20 mites
Pediculosis pubis

Erythematous macules or papules ± wheals and inguinal lymphadenopathy

Look closely for lice and nits

Permethrin 1% cream, apply to affected areas, wash off in 10 minutes.

Or

Pyrethrin piperonyl butoxide, apply to affected areas, wash off in 10 mins

Machine wash and machine dry any clothing, linens, or towels that were worn in 3 days prior to treatment Treat all sexual partners; notify all sexual partners within the past 3 months

Approximately 30% of those found to have pediculosis pubis also have concomitant infection with another sexually transmitted infection

Lindane not recommended. Ivermectin has limited ovicidal activity. Malathion only for treatment failure, has bad odor.

For eyelashes, apply petroleum jelly to eyelid margins bid x 10d
Seborrheic dermatitis Erythematous plaques with loose greasy scale Antifungal shampoos or creams ± low-potency topical corticosteroid creams (hydrocortisone, desonide) There is no cure, and the condition is expected to wax and wane
Intertrigo Erythema/erosions of opposing skin surfaces

Conservative measures aimed at eliminating friction, moisture

Barrier creams such as Desitin®

Diagnosis of exclusion; ...

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