How to treat dark and thickened groin skin after infection?

Question

Hello doctor,

I am a 35-year-old female with a history of extensive tinea cruris and tinea corporis affecting my buttocks, groin, and inner thighs a year ago. At the onset, the condition was marked by redness, itching, and scaling. I received both oral and topical antifungal medications based on previous prescriptions.

Although the active fungal infection cleared completely, the affected skin has stayed dark, thickened, dry, and scaly for the past one and a half years. I still experience occasional itching, especially when the skin is dry, but there is no redness, oozing, or active lesions now. No new patches have developed since the infection resolved.

The ongoing changes in skin color and texture are causing me significant cosmetic concern, and it is affecting my confidence and personal life. I had no chronic skin issues before the tinea episode. I do not have diabetes, immunosuppression, or any systemic illnesses.

I completed antifungal treatment a year ago, using both topical and oral medications. I have not used any recent antifungal or steroid creams. I also tried over-the-counter moisturizers, but they gave minimal improvement.

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understood your concern.

Here is what I think is going on with your skin: the thickening and dark patches are likely because of the long-lasting tinea infection you had. For now, you do not need any tests unless the tinea comes back. If it does, then we can do a simple scraping test called KOH (potassium hydroxide) to check for fungus. It could also be something like chronic eczema or lichen simplex chronicus (LCS), but most likely it is post-inflammatory hyperpigmentation with thickened skin.

To help with the thick, dry skin, you should use creams that have 10 % urea and 10 % lactic acid twice a day. Also, gently use a lotion with 2 % Salicylic acid once at night to exfoliate dead skin.

I suggest you follow the instructions below:

For the dark spots, apply Azelaic acid cream (10 to 20 %) two times a day. You can also try creams with Kojic acid and Vitamin C at night if they do not irritate your skin.
If the itching bothers you, non-sedating antihistamines during the day and sedating ones at night can help. Try not to scratch and avoid tight clothes.
General care is important too: take lukewarm baths, use mild cleansers, keep the area dry, and change your underwear after sweating.
Be careful not to use steroid creams in the groin area for a long time because they can make the pigmentation worse.
Most importantly, avoid scratching the skin as much as possible.

Let us review your progress in four to six weeks. If you have any new problems before that, please reach out.

I hope that this answers your query.

Kindly follow up if you have more doubts.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

I read your query and understood your concern.

Post-inflammatory hyperpigmentation with thickened skin after healed tinea. Start keratolytic moisturizer, Azelaic Acid cream, and an antihistamine as mentioned below:

Moisturizer with keratolytic: Moisturex cream, apply a thin layer twice daily over dark, thickened areas (avoid genitals and mucosa).
Pigment lightening: Azelaic Acid 20 % cream, apply at night over affected skin.
Anti-itch: Cetirizine 10 mg tablet, take one tablet once daily at night for 15 days.
Gentle cleanser: You can use Cetaphil Restoraderm or Sebamed liquid wash. Use once daily during bath.
Avoid scratching, wear loose cotton underwear, keep the area dry, and avoid using old steroid creams.

I hope that this answers your query.

Kindly follow up after six weeks, and if you have more doubts.

Thank you.