Jock Itch Is Not Fun In The Philippines

Trichophyton Rubrum Microconidia
by Medmyco licensed under CC0 1.0

Table Of Contents:

Tinea Cruris Strikes

Tinea cruris (aka jock itch) is a fungal infection most often caused by the fungus Trichophyton Rubrum. It is likely that I had the infection for weeks before I saw it. I had been working in the hot, humid and rainy environment clearing weeds and grass. I had noticed an occasional tingly mild burning sensation a few days into the work. Most of the time I felt nothing at all. After about two weeks the discomfort level increased just enough to warrant an inspection.

A Dark Red Rash

The blotch was about 2 1/2 inches across with cauliflower lobed edges and an angry red, raised and well-defined border. It was on my inner thigh going toward the perineum. It was horrifying. I quickly made an appointment to see a doctor and I was relieved to discover that what I had was a very common fungal infection. The doctor prescribed Ketoconazole. You do not need a prescription to purchase Ketoconazole in the Philippines and it can be found at most any local pharmacy.

Cause Of The Infection

Heat and sweat combined with chaffing of the skin provided the perfect opportunity for a micro-organism to enter the skin.

It is not possible to stay dry while working outside in hot and humid conditions. Less than five minutes after beginning work I am already streaming sweat. The day-time temp averages 90F with humidity also in the 90% range.

The solution is to always use fresh working clothes and to shower frequently. I also purchased Dr. Wong's Sulfur Soap and use it alternately with regular soap. I use a hair dryer to make sure that the area gets absolutely dry.

Week One Of Treatment

After four days later the Ketoconazole 2% seemed to be working well. I was advised that in order to prevent recurrence I must continue application of the drugs for 5-7 days beyond the point where the redness appears to clear up.

Week Two Of Treatment

The tentative diagnosis for my infection was Trichophyton rubrum.

I now have suspicions that a different microbe could be the culprit.

The reason I doubt the original diagnosis is twofold. First, I noticed the development of satellite lesions. Satellite lesions are red bumps/blisters outside of the main patch of affected skin. Satellite lesions are not supposed to occur with Trichophyton rubrum.

The second sign that I was dealing with something different is the fact that the scrotal area became affected. That is also not common with Trichophyton (though there is some argument).

I could be dealing with Intertrigo complicated by a Candida albicans super-infection.

Last week the infection the infection seemed to be healing due to the Ketoconazole. That did not last. I took my recovery for granted and spent a day working and sweating only to find that the infection has become inflamed again and the angry red border had returned.

That episode shocked me into getting a lot more serious about beating the infection.

For the past five days I have sworn off working and I have remained in the air conditioned room with the fan full blast on the affected area.

I cannot stress enough the importance of positioning a fan to blow directly on the affected area. I do this throughout the day and while sleeping. The redness fades away and the blisters/bumps dry out where the skin is exposed to the blowing air. This is crucial to keeping the infection dry so it can heal, especially in a tropical environment.

I continue to use Dr. Wong’s Sulfur Soap each day. The instructions say that the soap can be used specifically for skin infections. You are supposed to apply the lather and allow it to stay on the affected skin for several minutes. I have been doing that and the area is clearing more every day.

Be aware that overusing sulfur soap will cause irritation.

Despite the setback the skin is much lighter in color now and the angry red border has been reduced to just a few patchy pinkish bumps.

Recovery Is Slow

Generally, the consensus is that clearing jock itch takes around six weeks. It is also very common for there to be re-occurrences. I would guess that this is due to losing patience with treatment. I have only been treating the infection for two weeks and it is a super drag to go to the proper extent necessary to assure complete healing.

It occurred to me that a bio-film could be the reason for such slow and incomplete healing.

A quick search of Google proved that my hunch was correct. Whether I have T. rubrum or C. albicans does not matter. Both fungi produce bio-film.

What Is A Bio-Film And Why Does It Matter?

If you are familiar with the Philippines, then you probably know what nata de coco is. Nata de coco is bacterial cellulose produced by Acetobacter xylinum cultured in coconut water. Nata de coco is a bio-film. If you have ever eaten nata de coco, then you know that it is jelly-like, but also tough. I like to chew it. You will also note the faint scent and flavor of vinegar.

Bio-film matters to those of us with a skin infection because the bio-film insulates the fungal cells. The fungus lives on the skin keratin, so it is already insulated from the immune system by that fact. The bio-film insulates the fungus from anti-fungal medications like ketoconazle.

The bio-film can set up in as little as 24-72 hours.

I had few if any symptoms within that time frame. By the time you experience any real symptom that gets your attention and makes you check out the problem you already have a serious infection dug in and shielded with a bio-film.

The best way to beat that situation is to never get into it in the first place.

Intertrigo and other groin infections get their start with help from us.

By not taking care of our bodies when we are working in hot and humid environments we are playing number one advocate on the side of the fungus.

I will be a lot more cognizant of what is going on where skin meets skin and no more working in the rain or dragging my work day too long without a shower break to wash away the sweat and grime.

Week 10

Finally, after months of dealing with this PLAGUE, every single red dot is gone. Because of the climate and my active lifestyle AND the location of the affected area it was very difficult to get the condition completely resolved.

I am tentatively relieved and happy to say that it seems for the last week that I have completely recovered.

Many times it seemed that I had recovered and then I would do some traveling or spend the day working in the yard only to find that the condition had returned, albeit it just a tiny red dot. But that is how this entire ordeal began - with a tiny red dot.

My Treatment Summary

This is what worked for me. What works for you is up to you and your doctor.

Ketoconazole. Some people may be allergic. **You MUST continue to apply the medication for a MINIMUM of 7 days after all visible signs of infection have disappeared.

Run a fan on the affected area as much as possible to keep it dry.

If possible, keep the area uncovered during sleep.

Reduce or eliminate sugar. Excess sugar seems to make the infection harder to clear.

Maintain a healthy diet to keep your immune system up.

Get plenty of sleep. Lack of sleep negatively impacts immunity. Most of the time these infections remain in the keratin and beyond the reach of the immune system, but lack of sleep and poor diet may contribute to creating conditions that the microbes can take advantage of to invade the body.

Sulfur soap helped. Overuse can irritate the skin.

Dandruff shampoo on jock itch - Don't do it. It irritates the skin.

Do not allow the area to remain hot and covered with sweat for longer than absolutely necessary.

Shower immediately after work, workouts etc.

After showering pat dry and or blow dry the affected skin - not too hot.

Allow 4-8 weeks for the infection to heal completely.

If you do no keep up treatment the infection may never go away and it might get much worse and spread. Just because you cannot see the infection and it seems to be healed does not mean that you are cleared of the infection. Fungal colonies may still be present and those that remain will be the strongest of all, so if you stop treatment prematurely it will be these strongest and most resistant fungi that survive and they will multiply and become an infection that will be much more difficult to beat.

For this reason you must continue to apply the antifungal cream for a minimum of seven days beyond the point that no visible infection remains. Personally, I went 14 days beyond being visibly clear.

It is very difficult to overdose with ketoconazole cream. The amount of the drug present in the cream is a tiny fraction of the amount you will need to take orally if you fail to get the infection under control with the cream.