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Suggest Treatment For Itching In Groin Area
Question: Hi! Dr.
My name is XXXX 46 years old and I currently live in XXXXXXX I am a XXXXXXX level manager in a reputed organisation. I have a skin problem in my groin area and it has been persisting for long time. It is extremely itchy and now it is becoming unbearable and I have to go to washroom many times. I have gone to 2 different skin specialists for the same problem, it subsides for some days and it again flares up.
This condition started almost 2 years back and it has been up and down. First Dr. said that it is a kind of Liechen and he initially gave me a cream to locally apply and some medicines to avoid itching.
After 3 to 4 days it had subsided. Then again it started. Then he prescribed HHSone Cream and Teczine, that helped a bit. The penile part and buttocks area got cured and the itching in the scrotum persisted and periodically it went off. I continued to use the same for some more days, it got cured but again the itching started. Then I consulted another skin specialist for my eczema problem, there I discussed with him my groin itchy thing too. Then he said that the cream what I had been using were steroids and it will only worsen the condition over a period of time, hence he asked me to stop and he prescribed Zocon DT 50 and Teczine. He said it is only a fungal infection and not any Liechen. He asked me to apply some cream to avoid dryness and also sweaty condition. He also prescribed a cream but it was of no use. For my eczema problem, he had done biopsy and found that it is psoriasis and he prescribed methotexrate 5mg once a week and gradually increased from 5mg to 15 mg once a week, but neither there was any big improvement in my psoriasis problem nor this groin itching problem. After 3 months, I stopped using any medication. Currently I have gone to another skin specialist and she is treating my psoriasis problem and it has started healing well. But I could not discuss this problem as the Dr. is a lady. I started to use HH Sone once again and the itching subsided. For the last 2 months, I am not using any cream but I apply locally pure coconut oil to keep the area lubricated. Initially it was better and slowly it has again come back to same conditionWhen it is dry or sweaty, the situation worsens. The itching has now again spread to penile part, tip of the foreskin and towards my anus too. The scrotum is extremely itchy and it has thickened now.
I am quite careful in using my under garments. I keep my genitals always clean and have had sex only with my wife. Will this condition spread to my wife?
I would be grateful if you could suggest the right medication and a permanent cure.
My name is XXXX 46 years old and I currently live in XXXXXXX I am a XXXXXXX level manager in a reputed organisation. I have a skin problem in my groin area and it has been persisting for long time. It is extremely itchy and now it is becoming unbearable and I have to go to washroom many times. I have gone to 2 different skin specialists for the same problem, it subsides for some days and it again flares up.
This condition started almost 2 years back and it has been up and down. First Dr. said that it is a kind of Liechen and he initially gave me a cream to locally apply and some medicines to avoid itching.
After 3 to 4 days it had subsided. Then again it started. Then he prescribed HHSone Cream and Teczine, that helped a bit. The penile part and buttocks area got cured and the itching in the scrotum persisted and periodically it went off. I continued to use the same for some more days, it got cured but again the itching started. Then I consulted another skin specialist for my eczema problem, there I discussed with him my groin itchy thing too. Then he said that the cream what I had been using were steroids and it will only worsen the condition over a period of time, hence he asked me to stop and he prescribed Zocon DT 50 and Teczine. He said it is only a fungal infection and not any Liechen. He asked me to apply some cream to avoid dryness and also sweaty condition. He also prescribed a cream but it was of no use. For my eczema problem, he had done biopsy and found that it is psoriasis and he prescribed methotexrate 5mg once a week and gradually increased from 5mg to 15 mg once a week, but neither there was any big improvement in my psoriasis problem nor this groin itching problem. After 3 months, I stopped using any medication. Currently I have gone to another skin specialist and she is treating my psoriasis problem and it has started healing well. But I could not discuss this problem as the Dr. is a lady. I started to use HH Sone once again and the itching subsided. For the last 2 months, I am not using any cream but I apply locally pure coconut oil to keep the area lubricated. Initially it was better and slowly it has again come back to same conditionWhen it is dry or sweaty, the situation worsens. The itching has now again spread to penile part, tip of the foreskin and towards my anus too. The scrotum is extremely itchy and it has thickened now.
I am quite careful in using my under garments. I keep my genitals always clean and have had sex only with my wife. Will this condition spread to my wife?
I would be grateful if you could suggest the right medication and a permanent cure.
Brief Answer:
Provide more information; upload photographs
Detailed Answer:
Hello. Thanks for writing to us at healthcaremagic
I am, Dr. Kakkar. I have gone through your query.
So you have 2 issues:
-Groin itch (which was diagnosed initially as lichen planus and later on as fungal infection)
-Psoriasis (for which you are on Methotrexate)
I would like you to upload a few clear photographs of the affected skin so that I am able to guide you better, though i will keep a tentative diagnosis of Fungal Infection (Tinea Cruris) with Lichenification of the skin because of chronic scratching.
My second possibility would be of Flexural Psoriasis.
Psoriasis can involve the flexures like axilla, submammary folds, groin, perianal areas etc as well defined erythematous moist plaques.
I don't think it is an STD and therefore it won't spread to your wife
I would ask you to stop using coconut oil because it won't address the condition apart from just lubricating it.
Regards
Provide more information; upload photographs
Detailed Answer:
Hello. Thanks for writing to us at healthcaremagic
I am, Dr. Kakkar. I have gone through your query.
So you have 2 issues:
-Groin itch (which was diagnosed initially as lichen planus and later on as fungal infection)
-Psoriasis (for which you are on Methotrexate)
I would like you to upload a few clear photographs of the affected skin so that I am able to guide you better, though i will keep a tentative diagnosis of Fungal Infection (Tinea Cruris) with Lichenification of the skin because of chronic scratching.
My second possibility would be of Flexural Psoriasis.
Psoriasis can involve the flexures like axilla, submammary folds, groin, perianal areas etc as well defined erythematous moist plaques.
I don't think it is an STD and therefore it won't spread to your wife
I would ask you to stop using coconut oil because it won't address the condition apart from just lubricating it.
Regards
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
Dear Dr.
Thanks for your prompt reply.
I have uploaded photographs of my groin and right heel where I have Psoriasis thru the Upolad reports option. You may please check the reports section.
I am not currently on Methotexrate treatment. As per the recent Doctor's advise, I am applying only Halovit S cream on the Psoriasis part. I also have the problem of Fatty liver. SGOT & SGPOT levels went up hence I discontinued. I was also told that it suppresses immunization and my gastroenterologist asked me not to prolong the treatment.
Regards
XXXX
Thanks for your prompt reply.
I have uploaded photographs of my groin and right heel where I have Psoriasis thru the Upolad reports option. You may please check the reports section.
I am not currently on Methotexrate treatment. As per the recent Doctor's advise, I am applying only Halovit S cream on the Psoriasis part. I also have the problem of Fatty liver. SGOT & SGPOT levels went up hence I discontinued. I was also told that it suppresses immunization and my gastroenterologist asked me not to prolong the treatment.
Regards
XXXX
Brief Answer:
Seems like Scrotal LSC
Detailed Answer:
Hi.
I have reviewed the photographs.
The scrotal skin is thickened as can be seen from excessive rugosities; this is scrotal LSC (Lichen Simplex Chronicus). This is not fungal infection.
LSC is an itchy condition; as a result of chronic scratching the skin becomes thick with prominent skin markings.
The more you scratch the more the skin itches and therefore the more the desire to scratch. It becomes a cycle: itch-scratch-itch cycle that perpetuates LSC.
If, I was the treating doctor I would have asked you to apply a moderately potent topical steroid e.g either Mometasone furoate (you have already used it before) Or Betamethasone valerate cream, twice daily to the affected area for 2-3 weeks.
In patients of LSC relapse is a problem. Therefore, once your condition improves significantly within 2-3 weeks of twice daily application of topical steroids, you may taper the use of topical steroids gradually e,g by reducing the frequency of application of topical steroids to once daily for 1-2 weeks, followed by once every alternate days and then finally stop. This is one option.
Sudden withdrawal of topical steroids can precipitate a relapse of LSC.
Since steroids cannot be used for ever, therefore, once the condition has improved significantly on topical steroids, another option is to substitute with topical immunomodulators e.g tacrolimus.
Topical immunomodulators are effective in maintaining the improvement attained with topical steroids and can even be used for long term, if required and also there is no rebound phenonmena unlike steroids, once they are discontinued.
Topical immunomodulators are however not rapidly acting as compared to steroids, therefore they are not first line treatment of LSC.
Topical steroids and topical immunomodulators are prescription products and you won't find them OTC. Therefore, I would suggest that you seek an appointment with a doctor and get a prescription for these.
Oral antihistamine e,g cetrizine 10 mg once daily would provide you symptomatic relief from itching.
Regards
Seems like Scrotal LSC
Detailed Answer:
Hi.
I have reviewed the photographs.
The scrotal skin is thickened as can be seen from excessive rugosities; this is scrotal LSC (Lichen Simplex Chronicus). This is not fungal infection.
LSC is an itchy condition; as a result of chronic scratching the skin becomes thick with prominent skin markings.
The more you scratch the more the skin itches and therefore the more the desire to scratch. It becomes a cycle: itch-scratch-itch cycle that perpetuates LSC.
If, I was the treating doctor I would have asked you to apply a moderately potent topical steroid e.g either Mometasone furoate (you have already used it before) Or Betamethasone valerate cream, twice daily to the affected area for 2-3 weeks.
In patients of LSC relapse is a problem. Therefore, once your condition improves significantly within 2-3 weeks of twice daily application of topical steroids, you may taper the use of topical steroids gradually e,g by reducing the frequency of application of topical steroids to once daily for 1-2 weeks, followed by once every alternate days and then finally stop. This is one option.
Sudden withdrawal of topical steroids can precipitate a relapse of LSC.
Since steroids cannot be used for ever, therefore, once the condition has improved significantly on topical steroids, another option is to substitute with topical immunomodulators e.g tacrolimus.
Topical immunomodulators are effective in maintaining the improvement attained with topical steroids and can even be used for long term, if required and also there is no rebound phenonmena unlike steroids, once they are discontinued.
Topical immunomodulators are however not rapidly acting as compared to steroids, therefore they are not first line treatment of LSC.
Topical steroids and topical immunomodulators are prescription products and you won't find them OTC. Therefore, I would suggest that you seek an appointment with a doctor and get a prescription for these.
Oral antihistamine e,g cetrizine 10 mg once daily would provide you symptomatic relief from itching.
Regards
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Dear Dr.
Thanks for your suggestions.
However, I have a few more queries.
1. Is it Curable or only treatable?
2. The itching is spreading to my anal part and foreskin of my penis. How do i control it?
3. Should it be kept lubricated or kept dry?
4. Should I apply any dusting powder or should I use any emollients for lubrication? If so, then when should I apply? After applying the topical steroid cream or before applying steroid cream?
5. Please suggest a few topical steroids and topical immunomodulators.
6. Is there any topical cream available for preventing itching?
Thanks for your suggestions.
However, I have a few more queries.
1. Is it Curable or only treatable?
2. The itching is spreading to my anal part and foreskin of my penis. How do i control it?
3. Should it be kept lubricated or kept dry?
4. Should I apply any dusting powder or should I use any emollients for lubrication? If so, then when should I apply? After applying the topical steroid cream or before applying steroid cream?
5. Please suggest a few topical steroids and topical immunomodulators.
6. Is there any topical cream available for preventing itching?
Brief Answer:
LSC is curable; visit a dermatologist
Detailed Answer:
Hi.
Sorry for delay in my reply. I apologize.
-It is definitely curable but as I said it may flare again if partially treated or inadequately treated.
-Along with topical you also need to take oral treatment to suppress the desire to itch because the more you scratch the worse it will get(itch-scratch-itch cycle). Oral antihistamine thus comprise an important part of the overall treatment of LSC.
-You should not apply dusting powder because LSC is not a fungal infection neither it is caused by excess moisture.
-Moisturizers would provide a temporary relief (as you may have noticed with coconut oil). However you may use a moisturizing cream (rather than coconut oil) because the skin affected with LSC is dry.
Over the moisturizer you need to apply topical steroids, twice daily.
-Topical steroids that would be effective are mometasone furoate 0.1% and topical immunomodulators like tacrolimus 0.1% ointment would be useful. These are prescription drugs and ideally you need to visit a dermatologist in your region for a prescription of these.
It would be unethical on my part to prescribe you the brand names of the medicines on internet, because actually I have not had the opportunity to examine you.
My job here is to give you treatment options and give you pointers in the right directions, so that you are benefited from the information I provide.
A visual assessment is the best way to judge before we can prescribe medicines.
A dermatologist in your region would be able to examine you in person and would be in a better position to prescribe you the brand names
-Topical steroids would themselves control itching along with oral antihistamines e.g cetrizine or levocetrizine.
You don't need to use any other cream for itching.
Regards
LSC is curable; visit a dermatologist
Detailed Answer:
Hi.
Sorry for delay in my reply. I apologize.
-It is definitely curable but as I said it may flare again if partially treated or inadequately treated.
-Along with topical you also need to take oral treatment to suppress the desire to itch because the more you scratch the worse it will get(itch-scratch-itch cycle). Oral antihistamine thus comprise an important part of the overall treatment of LSC.
-You should not apply dusting powder because LSC is not a fungal infection neither it is caused by excess moisture.
-Moisturizers would provide a temporary relief (as you may have noticed with coconut oil). However you may use a moisturizing cream (rather than coconut oil) because the skin affected with LSC is dry.
Over the moisturizer you need to apply topical steroids, twice daily.
-Topical steroids that would be effective are mometasone furoate 0.1% and topical immunomodulators like tacrolimus 0.1% ointment would be useful. These are prescription drugs and ideally you need to visit a dermatologist in your region for a prescription of these.
It would be unethical on my part to prescribe you the brand names of the medicines on internet, because actually I have not had the opportunity to examine you.
My job here is to give you treatment options and give you pointers in the right directions, so that you are benefited from the information I provide.
A visual assessment is the best way to judge before we can prescribe medicines.
A dermatologist in your region would be able to examine you in person and would be in a better position to prescribe you the brand names
-Topical steroids would themselves control itching along with oral antihistamines e.g cetrizine or levocetrizine.
You don't need to use any other cream for itching.
Regards
Above answer was peer-reviewed by :
Dr. Prasad
Dear Dr. Kakkar
Thanks a lot for your valuable suggestions. Actualy, I am in the process of moving from my current location to XXXXXXX I may have to meet a Doctor there as there is no point in meeting any Doctor here in XXXXXXX as I will be moving to XXXXXXX within a few days.
I will certainly go as per your advise. If I have to meet you in person, Can I know from which location you operate? I keep travelling to almost all important cities in XXXXXXX Is it possible to meet you? Please suggest.
Until then, Thanks once again.
Thanks a lot for your valuable suggestions. Actualy, I am in the process of moving from my current location to XXXXXXX I may have to meet a Doctor there as there is no point in meeting any Doctor here in XXXXXXX as I will be moving to XXXXXXX within a few days.
I will certainly go as per your advise. If I have to meet you in person, Can I know from which location you operate? I keep travelling to almost all important cities in XXXXXXX Is it possible to meet you? Please suggest.
Until then, Thanks once again.
Brief Answer:
You are welcome
Detailed Answer:
Hi.
Thanks for appreciating. I agree with you. I think it would be better to see a doctor at your new place.
Presently I am only into research work with CIDP Biotec pvt Ltd.
We are conducting specialized and tailored clinical trials in the field of cosmetics and dermatology across various countries.
It is a clinical research organisation.
However, you may contact me directly via this forum. Here is my profile: http://doctor.healthcaremagic.com/doctors/dr-kakkar-s/66939
Regards
take care
You are welcome
Detailed Answer:
Hi.
Thanks for appreciating. I agree with you. I think it would be better to see a doctor at your new place.
Presently I am only into research work with CIDP Biotec pvt Ltd.
We are conducting specialized and tailored clinical trials in the field of cosmetics and dermatology across various countries.
It is a clinical research organisation.
However, you may contact me directly via this forum. Here is my profile: http://doctor.healthcaremagic.com/doctors/dr-kakkar-s/66939
Regards
take care
Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation
Above answer was peer-reviewed by :
Dr. Prasad
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