Itching in the groin as a symptom of disease

Considering the purely medical aspect of the problem of skin itching, in most cases, specialists consider pathological itching in the groin as a symptom of a disease or a painful condition, and this spectrum includes not only localized infections and dermatoses.

In the etiological classification of chronic pruritis prepared by specialists from the International Forum for the Study of Itch (IFSI), regardless of localization, it is proposed to distinguish between dermatological, systemic, neurological, somatoform (in the pathogenesis of which psychiatric and psychosomatic factors play a decisive role) and mixed-origin itching (that is, there are several causes).

But in the absence of a clear answer to the question of why itching occurs in the folds of skin in the groin, doctors call it idiopathic.

Itching in the groin with hyperhidrosis and systemic diseases

When the first signs such as local hyperemia of the skin appear, that is, its redness and itching in the groin, among the versions of their origin, diaper rash in the groin is considered, especially in people with excess fatty tissue, which increases all skin folds. [ 1 ], [ 2 ] Due to diaper rash, itching under the breast and in the groin - with irritation and hyperemia - bothers most obese women suffering from hyperhidrosis (excessive sweating). [ 3 ], [ 4 ]

There is no doubt that the problem of hyperhidrosis, which is often associated with itching between the legs in the groin, is a medical one. The apocrine sweat glands located in the groin area (which are “turned on” only with the onset of puberty) produce sweat that is different from that produced by the eccrine sweat glands of the skin of the entire body. In addition, the secretions of the apocrine glands enter the hair follicles, and bacteria colonizing the skin of the groin folds, perineum and perianal area decompose these secretions, which explains the itching and unpleasant odor in the groin. [ 5 ], [ 6 ]

Inguinal (inguinal) hyperhidrosis in adults and children (especially when the body is overheated) can lead to miliaria - prickly heat, in which transparent, fluid-filled vesicles and papules form at the site of blocked eccrine sweat glands, often transforming into pustules (bubbles). If they become inflamed, they fill with purulent exudate, and then there may be itching in the groin and discharge when scratching. Sweat glands in infants and small children are not fully developed, so itching in the groin associated with prickly heat in a child is observed much more often than in adults.

Inflammation of the sweat apocrine glands also develops, called inguinal hidradenitis (Verneuil's disease) - with the appearance at the initial stage of an inflamed nodule (red or bluish), causing itching, discomfort, and then painful sensations. In this case, itching in the groin in women with inguinal hyperhidrosis is observed more often than in men, since they have a larger number of inguinal apocrine glands. [ 7 ], [ 8 ]

Everything is interconnected in the human body. Pathologically high sweating, including that focused in the groin - with a high risk of skin itching, accompanies some systemic diseases, including primary hyperparathyroidism, hemochromatosis, reactive arthritis, irritable bowel syndrome, metabolic syndrome, etc.

Up to 10% of patients complain of itching in the groin with diabetes; manifestations of this symptom are observed in chronic nephrological diseases, with lymphostasis - a long-term violation of the outflow of lymph. [ 9 ] And in a number of malignant hematological and lymphoproliferative diseases, in particular, lymphocytic leukemia and cutaneous T-cell lymphomas, almost a third of patients have one of the symptoms - an increase in regional lymph nodes and itching of the lymph nodes in the groin, in the armpits or on the neck. In this case, there may be no rash, but the appearance of reddish or purple scaly spots is not excluded, so itching and peeling in the groin can easily be confused with eczema, psoriasis or dermatitis.

Itching in the groin is a symptom of infections and dermatological diseases

Skin reactions accompany many infections. Thus, local irritation, burning and itching in the groin are symptoms of acariasis invasion and helminthiasis. With scabies, which develops when infected with the Sarcoptes scabiei mite, red pimples appear on the skin in the groin and itch, especially at night. [ 10 ], [ 11 ]

Also, night itching in the groin can be a symptom of an infestation with roundworms, pinworms (Enterobius vermicularis). With pinworms, children and adults experience itching in the groin and anus (rectal itching). [ 12 ], [ 13 ]

Skin lesions caused by viral infections can also cause rashes of various types and persistent severe itching in the groin. Such viruses include:

• herpes simplex virus (HSV type 2) and zoster virus (ZV), which cause genital herpes with itchy and painful rashes; [ 14 ]
• Human papillomavirus (HPV) is the cause of genital warts; [ 15 ], [ 16 ]
• Molluscum contagiosum virus (MCV) of the Poxviridae family, which manifests itself as small, round (white-pink or flesh-colored) pinhead-sized papules protruding from the skin surface - single or multiple. The papules may enlarge, swell, become red, and inflamed (especially when scratched). [ 17 ], [ 18 ]

Itching in the groin and discharge with an unpleasant odor are observed in patients with infections transmitted mainly sexually (trichomoniasis, gardnerellosis, chlamydia, gonorrhea). Itching in the groin appears especially often in women with these diseases.

Pubic itching in women caused by bacteria of the genus Pseudomonas is a sign of folliculitis – inflammation of the hair follicles with rashes similar to acne. This infection develops after swimming in ponds, pools, taking baths and even from wearing a wet swimsuit. [ 19 ]

And when the commensal bacterium Corynebacterium minutissimum, which lives on the skin, is activated, erythrasma is diagnosed, which is characterized by the appearance of yellow-brown spots with the destruction of skin keratin, resulting in slight itching and flaking in the groin. [ 20 ], [ 21 ]

The main causes of itching in the groin during pregnancy are described in detail in the publication - Itching during pregnancy

Also, possible causes of itching in the groin in men are discussed in the material - Itching, burning and redness in the intimate area in men

As a result of untimely diaper changes, itching in the groin of the child appears, which indicates the so-called diaper dermatitis; its manifestations include erythema, small pinpoint rash, burning and itching in the left, right groin, in the anal area and between the buttocks.

Among fungal infections - skin mycoses, in which itching in the groin with swelling, redness and rashes appears, dermatologists note:

• cutaneous candidiasis of the inguinal folds or inguinal fungemia caused by yeast-like fungi Candida spp., accompanied by rashes in the form of spots and papules; [ 22 ]
• inguinal epidermophytosis (also called ringworm), the most commonly identified pathogens of which are the dermatophyte fungi Epidermophyton floccosum and Trichophyton mentogrophytes. Redness of the skin and a ring-shaped rash with scaling along the outer border of the spots can spread downwards - to the inner thighs, as well as to the perineum and genital area. This disease is more often detected in men.

Itching in the groin appears as one of the symptoms of skin diseases that are not associated with infection (that is, not contagious), in particular:

• simple contact dermatitis; [ 23 ],
• prurigo or prurigo; [ 24 ]
• allergic dermatitis; [ 25 ]
• autoimmune dermatological diseases – atopic dermatitis, psoriasis, lichen planus and lichen simplex or neurodermatitis. [ 26 ]

Neuropathic itching in the groin

Pruritus is a common symptom of nerve and nervous tissue damage in the absence of any skin disease and without any noticeable physiological stimuli in the periphery, in combination with or independently of neuropathic pain.[ 27 ]

To date, a connection has been established between itching of the skin in the groin and genital area and damage to the nerve roots extending from the spinal cord in the lumbar or sacral part of the spine, as well as spinal vascular malformations. [ 28 ]

Neurogenic causes – pathologies of the thalamus, parietal lobe, substantia nigra of the midbrain – can cause itching without a rash in patients with neurasthenia, multiple sclerosis, Parkinson's disease, dementia, obsessive and panic disorders, schizophrenia. [ 29 ]

Spots in the groin without itching

IFSI experts associate non-itchy groin spots with seborrheic keratosis, although this term is not very appropriate, since the skin's sebaceous glands (glandula sebacea) are not involved in this condition.

It has been observed that almost all adults over 60 years of age have at least one - flat or in the form of a raised plaque - spot resembling a wart, which is absolutely harmless and is considered a sign of skin aging and its local degenerative changes. But the exact cause of such keratosis has not yet been determined. [ 30 ]

It is worth remembering that moles (nevi), birthmarks, and superficial or capillary hemangiomas may be found in the groin area of infants. However, many hemangiomas disappear without a trace by about one and a half years of age. [ 31 ], [ 32 ]

Complications and consequences

When groin itching is not just an occasional problem, but a chronic symptom of a systemic pathology, it can significantly affect the quality of life, because therapy for acute itching often does not improve the condition when the symptom is chronic.

Itching can be debilitating and lead to poor sleep, which can lead to depression. According to experts from the European Academy of Dermatology and Venereology (EADV), the depression of many patients with chronic itching is so severe that surveys have shown that they would prefer to live less to be free of this symptom. According to research, the negative impact of chronic itching on quality of life is comparable to chronic pain.

In addition, the consequences and complications in the form of diffuse, severe inflammation (acute and chronic) are a consequence of the addition of streptococci and staphylococci to the main infection and the development of a super-infection.

Diagnostics groin itching

Since the effectiveness of treatment for this fairly common and extremely annoying symptom depends on the precise identification of the underlying cause, qualified medical care is necessary. Which doctor should you see if you experience this symptom? You need to see a dermatologist.

What tests can be prescribed, how instrumental diagnostics are used and differential diagnostics are carried out – between itching caused by a systemic disease and itching that is a symptom of a skin disease – are described in detail in the publications:

• Diagnosis of skin itching
• Skin examination

Read also:

• Itching in the groin: main causes and risk factors
• Treatment for itchy skin in the groin