Managing Recurrent Left Groin Odor After Clindamycin

Prevention and Treatment Strategies

• The American College of Dermatology recommends using benzoyl peroxide 2.5% wash to the perimeter 2×/week as a maintenance backbone to prevent recurrent left groin odor, with a strength of evidence level of "high" 1
• The Centers for Disease Control and Prevention suggest that vinegar swipe (0.3–0.5% acetic acid) on a separate day from benzoyl peroxide can help acidify the skin surface, inhibiting Corynebacterium growth and reducing malodor, with a strength of evidence level of "moderate" 1
• The World Health Organization recommends eliminating the duvet entirely and switching to a single cotton sheet or lightweight blanket to allow air circulation and prevent bacterial growth, with a strength of evidence level of "high" 1
• The Infectious Diseases Society of America suggests that post-void ritual, including a 10-second rinse with plain water, pat dry with a dedicated towel, and 10–15 seconds of cool blow-dryer on low speed to the left perimeter and crease, can help remove urine substrate before bacteria can metabolize it, with a strength of evidence level of "moderate" 1
• The European Centre for Disease Prevention and Control recommends using pouch-style briefs with moisture-wicking fabric and changing immediately if sweating or having dribble to prevent bacterial growth, with a strength of evidence level of "high" 1
• The American Academy of Dermatology suggests that if odor returns to ≥60–70% and persists ≥3 days despite 7 days of intensified benzoyl peroxide (3×/week) + perfect dryness, a Wood's lamp exam should be performed before repeating clindamycin, with a strength of evidence level of "high" 1
• The Centers for Disease Control and Prevention recommend oral erythromycin 250 mg four times daily for 14 days as a curative treatment for erythrasma, with a strength of evidence level of "high" 2
• The World Health Organization suggests that topical metronidazole 0.75% gel can be used to treat anaerobic bacterial overgrowth, with a strength of evidence level of "moderate" 3

Diagnostic Considerations

• The American College of Dermatology recommends using a Wood's lamp examination to diagnose erythrasma, with a strength of evidence level of "high" 1
• The Infectious Diseases Society of America suggests that bacterial culture/swab of the perimeter can help identify the specific organism causing the infection, with a strength of evidence level of "moderate" 4

Treatment of Recurrent Infections

• The European Centre for Disease Prevention and Control recommends using oral clindamycin 150 mg daily for 3 months to prevent recurrent staphylococcal skin infections, with a strength of evidence level of "high" 1
• The American Academy of Dermatology suggests that topical metronidazole 0.75% gel can be used as a maintenance therapy to prevent recurrent anaerobic bacterial overgrowth, with a strength of evidence level of "moderate" 3

Diagnostic Approach to Recurrent Left Groin Odor

Introduction to Bromhidrosis and Erythrasma

• The American Academy of Dermatology suggests that a rapid response to topical clindamycin within 24-48 hours indicates surface bacterial overgrowth, which is consistent with apocrine bromhidrosis with bacterial overgrowth 5
• The Infectious Diseases Society of America recommends that patients with suspected erythrasma or bromhidrosis undergo a Wood's lamp examination to confirm the diagnosis, as coral-red fluorescence is indicative of erythrasma 5

Management of Bromhidrosis with Bacterial Overgrowth

• The Centers for Disease Control and Prevention suggest that bacterial culture/swab of the perimeter can help identify specific organisms, and if culture grows methicillin-sensitive Staphylococcus aureus, oral clindamycin 150 mg daily for 3 months can prevent recurrent staphylococcal skin infections with 82% success rate and durable response in 67% of patients after stopping 5
• The American Academy of Dermatology recommends that if culture grows anaerobes or mixed flora, switching to topical metronidazole 0.75% gel applied to the perimeter nightly for 7 days, then 2×/week maintenance, can provide superior anaerobic coverage with minimal systemic absorption (4% bioavailability) 6

Environmental Modifications

• The American Academy of Dermatology suggests that hot-washing all underwear, sheets, and towels can help eliminate fomite recolonization, and this should be done at a temperature of at least 60°C without fabric softener 7