DEAR DR. ROACH: I am a 74-year-old male, and for the past two years, I have been unable to rid myself of a stubborn case of jock itch. I have tried all of the over-the-counter ointments, powders, and antifungal and antibacterial soaps without success. My dermatologist prescribed econazole nitrate cream 1%, which keeps it from getting worse but does not rid me of the problem. Do you have any other recommendations on how to treat this? — I.F.

ANSWER: The first concern is whether the diagnosis is correct. Many people are able to recognize the typical symptoms of tinea cruris, aka the fungal infection that is commonly called “jock itch.” But there are different fungi and even bacteria that can mimic the infection and do not respond to the usual treatments. Even seborrheic dermatitis and psoriasis may be confused for jock itch.

Given how long this has been going on, I would expect your dermatologist to perform a scraping and culture of the infected area so that the microbiology lab can identify the condition correctly.

If it is Trichophytin rubrum, which is the usual cause of jock itch, then recalcitrant cases can often be effectively treated with oral antifungal agents such as terbinafine. You can give your treatment a better chance by keeping the area dry (with dessicant powders such as corn starch) and avoiding tight-fitting clothing. Cotton is your friend because it allows air to pass through easily.

DEAR DR. ROACH: I have had peripheral neuropathy in my feet for over a year. I feel like I am walking on glass sometimes or on sharp stones. I cannot walk barefoot. I have seen a podiatrist and neurologist, but they are no help. The neurologist just wanted to keep increasing my gabapentin every time I went in for follow-ups.

Is there any cure or treatments that could help? One of my friends who has the same problem said that his doctor put him on venlafaxine, and it seemed to help. — S.S.

ANSWER: “Neuropathy” is a general term for a nerve problem, and “peripheral neuropathy” specifies that the problem is not in the spinal cord. There are many causes of neuropathy, but unfortunately, few of them have specific remedies.

One exception is when there is direct pressure on a nerve. Relieving the pressure can solve the problem, although the degree of recovery is never certain. An EMG (electromyography) test is the first step in trying to identify the cause of a neuropathy, but imaging (like a CT scan or an MRI) may be used if nerve compression is suspected. There are many rare causes; Lyme disease is endemic where I practice, so a blood test for Lyme is always prudent.

Diabetic neuropathy is the most common cause of nerve pain in both feet that I see. It is usually found in people who have had diabetes for many years that is often not well-controlled, but I have seen it in people who were recently diagnosed (although they may have had diabetes for years without knowing). In these cases, getting the diabetes under better control can help.

Gabapentin is a commonly used treatment for many kinds of peripheral neuropathies. While I understand your frustration, it is true that the dose often needs to be high to get relief. For the neuropathic pain that is associated with shingles, for example, the dose used in the study was 1,200 mg three times daily, which can take months of slowly increasing the dose for a person to tolerate.

Venlafaxine is a medicine that is usually used for depression, but it is helpful for many people with chronic nerve pain. However, neither gabapentin nor venlafaxine will take away the pain completely.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. (c) 2026 North America Syndicate Inc.

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