Itching in the groin as a symptom of the disease

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

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

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

Itching in the groin with hyperhidrosis and systemic diseases

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

Without a doubt, 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 (which “turn on” only at the onset of puberty) produce different sweat from the eccrine sweat glands 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 region decompose these secretions, which explains the itching and foul odor in the groin. [5], [6]

Inguinal (inguinal) hyperhidrosis in adults and children (especially when the body overheats) can lead to millaria - prickly heat  , in which, in place of blocked eccrine sweat glands, transparent, fluid-filled vesicles and papules are formed, 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 during scratching. Sweat glands in infants and young children are not fully developed, so prickly itching in the groin associated with prickly heat is much more common in a child than in adults.

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

In the human body, everything is interconnected. Pathologically high sweating, including focused in the groin - with a high risk of itching, is accompanied by 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 lymph outflow. [9] And in a number of malignant hematological and lymphoproliferative diseases, in particular, lymphocytic leukemia and cutaneous T-cell lymphomas, in almost a third of patients, one of the symptoms is an increase in regional lymph nodes and itching of lymph nodes in the groin, armpits or neck. In this case, there may not be a rash, but the appearance of reddish or purple scaly spots is not excluded, so itching and flaking in the groin can be easily confused with eczema, psoriasis or dermatitis. 

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

Skin reactions are accompanied by many infections. So, local irritation, burning and itching in the groin are symptoms of acariasis invasion and helminthiasis. With  scabies that develops when infected with a sarcopter mite (Sarcoptes scabiei,), red pimples that appear on the skin in the groin itch, especially at night. [10], [11]

Also, nighttime itching in the groin can be a symptom of infestation by round helminths pinworms (Enterobius vermicularis).  With  pinworms in children  and adults, itching in the groin and anus (rectal itching) is noted. [12], [13]

Skin lesions with a viral infection can also cause rashes of a different nature and constant severe itching in the groin. These viruses include:

• herpes simplex virus (HSV type 2) and zoster virus (WZ), leading to the development of  genital herpes  with itchy and painful rashes; [14]
• papillomavirus (HPV) - the cause of  genital warts ; [15], [16]
• Molluscum contagiosum virus is a contagious molluscum (MCV) of the Poxviridae family, which is manifested by small round (white-pink or flesh-colored) formations protruding above the skin surface, the size of a pinhead - single or multiple. Papules may become enlarged, swollen, reddened, and inflamed (especially when scratching). [17], [18]

Itching in the groin and discharge with an unpleasant odor are observed in patients with  infections that are primarily sexually transmitted  (trichomoniasis, gardnella, chlamydia, gonorrhea). Especially often with these diseases, itching appears in the groin in women.

Pseudomonas-induced itching on the pubis in women is a sign of folliculitis, an inflammation of the hair follicles with acne-like rashes. This infection develops after swimming in ponds, pools, taking baths, and even wearing a wet swimsuit. [19]

And when the commensal bacteria 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, as a result of which there is slight itching and peeling 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, the possible causes of itching in the groin in men are discussed in the material -  Itching, burning and redness in the intimate area in men

Due to the untimely change of diapers, itching appears in the groin of the child, which indicates the so-called diaper dermatitis; its manifestations include erythema, small pinpoint rash, burning and itching in the left, right groin, anus and between the buttocks.

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

• cutaneous candidiasis of inguinal folds or inguinal fungemia due to yeast-like fungi Candida spp., accompanied by rashes in the form of spots and papules; [22]
• n Akhova athlete's  (also called ringworm) identified pathogens that are often mushroom-and Epidermophyton floccosum dermatophytes Trichophyton mentogrophytes. Redness of the skin and a ring-shaped rash with peeling along the outer border of the spots can spread down to the inner thighs, as well as to the perineum and genital area. This disease is more common 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  pruritus ; [24]
• allergic dermatitis ; [25]
• autoimmune dermatological diseases - atopic dermatitis, lichen planus psoriasis (Lichen planus) and lichen simplex (Lichen simplex or neurodermatitis). [26]

Neuropathic itching in the groin

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

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

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

Groin spots without itching 

IFSI experts associate patches in the groin without itching with seborrheic keratosis, although this term is not very appropriate, since the sebaceous glands of the skin (glandula sebacea) are not relevant to this condition.

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

Do not forget that moles (nevi), birthmarks, as well as superficial or capillary hemangiomas can be found in the groin area of babies. At the same time, many hemangiomas disappear without a trace by about one and a half years. [31], [32]

Complications and consequences

When inguinal itching is not just an occasional problem, but a chronically manifested sign of systemic pathology, it can significantly affect the quality of life, because therapy for acute pruritus often does not improve the condition with the chronic nature of this symptom.

Itching can be debilitating and can lead to poor sleep, which can lead to depression. According to experts from the European Academy of Dermatology and Venereology (EADV), the state of depression of many patients with chronic itching is so severe that, according to surveys, they would prefer to live less, but be free from this symptom. Studies have shown that 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, severely passing inflammations (acute and chronic) are the result of the addition of strepto and staphylococci to the main infection and the development of a super-infection.

Diagnostics of the itchy groin

Since the effectiveness of treatment for this fairly common and extremely annoying symptom depends on the exact identification of the underlying cause, qualified medical attention is needed. Which doctor should you see if you experience this symptom? You need to go to an appointment with a dermatologist.

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

• Diagnosis of pruritus
• Skin examination