From the Guidelines
Fungal intertrigo should be treated with topical antifungal medications such as clotrimazole, miconazole, or nystatin, and keeping the infected area dry is crucial. This approach is based on the guidelines for treatment of candidiasis, which suggest that nonhematogenous primary skin infections, including intertrigo, can be effectively managed with topical azoles and polyenes 1. The importance of keeping the area dry is also emphasized in another study from 2000, which highlights the effectiveness of topical treatments and the need for dryness in managing candidal skin infections and paronychia 1.
Key Considerations for Treatment
- Topical antifungal medications are the first line of treatment for fungal intertrigo.
- Keeping the infected area dry is essential for preventing the growth of fungi.
- For more severe cases or in patients with specific conditions such as diabetes or obesity, closer monitoring and possibly oral antifungals may be considered, although the provided evidence does not directly address the use of oral antifungals for intertrigo.
Preventing Recurrence
- Regular use of antifungal powders can help prevent recurrence.
- Maintaining good hygiene practices, such as thoroughly drying the skin after bathing and using absorbent powders in skin folds, is important.
- Wearing loose-fitting, breathable clothing can reduce friction and moisture accumulation, creating an environment less conducive to fungal growth.
Given the information from the most recent and relevant study 1, which provides comprehensive guidelines for the diagnosis and management of skin and soft tissue infections, including fungal infections, the focus remains on topical treatment and preventive measures for fungal intertrigo. However, this study primarily addresses more severe and complex infections, underscoring the importance of proper diagnosis and management to prevent such complications. For fungal intertrigo, the approach remains centered on topical antifungal therapy and maintaining dry, clean conditions to prevent fungal growth and recurrence.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Fungal Intertrigo
- Fungal intertrigo, also known as intertriginous dermatitis, is a common inflammatory skin disorder caused by skin-on-skin friction within skin folds, as a result of moisture becoming trapped because of poor air circulation 2.
- It can occur in any area of the body where two skin surfaces are in close contact with each other, such as the axillary, inframammary, umbilical and inguinal areas, and is strongly associated with obesity 2.
- The treatment of fungal intertrigo is based on topical antifungal agents, with a topical antifungal agent being the first choice to treat Candida intertrigo 3.
- Clotrimazole, nystatin and miconazole are the most studied topical drugs and demonstrated similar efficacy with complete cure rates of 73%-100% 4.
- In addition to topical treatment, predisposing factors should be eradicated or amended, and an other superficial site of infection must be looked for and a source of infection should be investigated and eradicated 3.
Treatment Options
- Topical therapies such as azoles, terbinafine or tolnaftate are used to treat intertrigo and tinea corporis 3, 5.
- Systemic antifungal agents such as itraconazole are indicated in case of poor compliance to topical agents, in prophylaxis of highly relapsing disease, in oesophageal candidiasis and in Candida onychomycosis 3, 6.
- Oral fluconazole demonstrated similar efficacy to oral ketoconazole and topical clotrimazole, and is the only commercially available evidence-based option for systemic treatment of cutaneous candidiasis 4.
Prevention and Management
- Consensus clinical expert opinion suggests that investment in the development and adoption of clear skin care and skin fold management protocols can lead to improvements in the patient experience and better clinical outcomes 2.
- Accurate diagnosis is necessary for effective treatment, and diagnosis is usually based on history and clinical appearance plus direct microscopy of a potassium hydroxide preparation 5.
- Treatment requires attention to exacerbating factors such as skin moisture and choosing an appropriate antifungal agent 5.