From the Guidelines
Intertrigo should be treated with a combination of keeping the affected area dry, reducing friction, and addressing any secondary infections, with topical antifungals like clotrimazole, miconazole, or nystatin being effective for fungal infections, as recommended by the Infectious Diseases Society of America 1. Intertrigo is a common inflammatory skin condition that occurs in skin folds where surfaces touch and rub against each other, creating a warm, moist environment that promotes inflammation and secondary infection.
Key Considerations
- Treatment of intertrigo focuses on keeping the affected areas dry, reducing friction, and addressing any secondary infections.
- For mild cases, the first step is to gently cleanse the area with water or a pH-balanced cleanser, thoroughly dry the skin, and apply zinc oxide barrier creams or petrolatum to protect the skin.
- Moisture-wicking fabrics and loose clothing should be worn to reduce friction and moisture accumulation.
Management of Secondary Infections
- For cases with fungal infection, topical antifungals like clotrimazole, miconazole, or nystatin should be applied twice daily for 2-4 weeks, as supported by guidelines from the Infectious Diseases Society of America 1.
- If bacterial infection is present, topical antibiotics such as mupirocin or clindamycin may be necessary.
- For more severe or persistent cases, low-potency topical corticosteroids like hydrocortisone 1% can be applied sparingly twice daily for up to 7 days to reduce inflammation.
- Alternatively, topical calcineurin inhibitors like pimecrolimus or tacrolimus may be used, especially in intertriginous areas, as supported by a double-blind RCT of 57 patients with intertriginous psoriasis 1.
Prevention
- Prevention involves keeping skin folds dry, using absorbent powders like cornstarch, maintaining good hygiene, and for overweight individuals, weight loss may help reduce the severity and recurrence of intertrigo.
- It is essential to note that the most recent and highest quality study 1 supports the use of topical calcineurin inhibitors for the treatment of intertriginous psoriasis, which can be applicable to intertrigo management.
From the Research
Definition of Intertrigo
- Intertrigo is a superficial inflammatory dermatitis occurring on two closely opposed skin surfaces as a result of moisture, friction, and lack of ventilation 2.
- It is a common inflammatory skin disorder caused by skin-on-skin friction in skin folds, due to moisture becoming trapped because of poor air circulation 3, 4.
- Intertrigo can affect individuals of all ages and 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 3, 4.
Treatment of Intertrigo
- Fungal lesions are treated with topical nystatin, clotrimazole, ketoconazole, oxiconazole, or econazole 2.
- Secondary streptococcal infections are treated with topical mupirocin or oral penicillin 2.
- Corynebacterium infections are treated with oral erythromycin 2.
- Resistant cases of candidal intertrigo may require oral fluconazole therapy 2.
- The use of moisture-wicking textiles within skin folds can help reduce skin-on-skin friction, wick away moisture, and reduce secondary infection 3.
- Topical therapies such as clotrimazole, nystatin, and miconazole have demonstrated similar efficacy with complete cure rates of 73%-100% in the treatment of cutaneous candidiasis, which can be associated with intertrigo 5.
Prevention and Management
- Identifying predisposing factors and educating patients in reducing these can help prevent intertrigo 3.
- Educating patients in skin fold management and adopting a structured skin care routine can also help prevent intertrigo 3.
- 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 4.