From the Guidelines
Compounded topical preparations for intertrigo in the USA should include a combination of antifungals, such as nystatin, and topical azoles or polyenes, including clotrimazole, miconazole, as recommended by the Infectious Diseases Society of America 1. The treatment of intertrigo involves addressing the fungal and bacterial components of the infection, as well as reducing inflammation.
- A commonly recommended formulation is a combination of nystatin (antifungal), triamcinolone (corticosteroid), and either mupirocin or metronidazole (antibacterial) in a zinc oxide base.
- The typical concentration would be nystatin 100,000 units/g, triamcinolone 0.1%, and mupirocin 2% or metronidazole 0.75%.
- This should be applied thinly to affected areas twice daily for 7-14 days.
- For severe cases, the preparation might include higher potency corticosteroids like betamethasone 0.05% instead of triamcinolone, though this should be used for shorter durations (5-7 days) to avoid skin atrophy.
- Patients should be instructed to keep the affected areas clean and dry, using absorbent powders like zinc oxide or cornstarch between applications, as emphasized by the guidelines for treatment of candidiasis 1.
- If the condition doesn't improve within 7 days or worsens, patients should seek follow-up care as systemic therapy may be needed.
- It's also important to note that nonhematogenous primary skin infections typically occur as intertrigo in skin folds, especially in obese and diabetic patients, and that keeping the infected area dry is crucial 1.
From the Research
Compounded Topicals for Intertrigo in the USA
- Intertrigo 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 2, 3.
- The diagnosis, management, and prevention of intertrigo involve identifying predisposing factors, educating patients in skin fold management, and adopting a structured skin care routine 2.
- Topical agents may be used to treat secondary infections, and moisture-wicking textiles can help reduce skin-on-skin friction and prevent secondary infection 2.
- There is a lack of well-designed studies to test proposed interventions for intertrigo, and the quality of evidence remains low 2.
- Clotrimazole, nystatin, and miconazole are effective topical treatments for cutaneous candidiasis, a common cause of intertrigo, with complete cure rates of 73%-100% 4.
- Compounded topicals may be used to treat intertrigo, but there is limited evidence to support their use, and more research is needed to determine their effectiveness 4.
Treatment Options
- Topical antifungal agents, such as clotrimazole, nystatin, and miconazole, are commonly used to treat intertrigo 4.
- Moisture-wicking textiles and structured skin care routines can help prevent intertrigo and reduce the risk of secondary infection 2, 3.
- Systemic treatments, such as oral fluconazole, may be used in severe cases of intertrigo, but are typically reserved for cases that do not respond to topical treatment 4.
Prevention and Management
- Identifying predisposing factors, such as obesity, and educating patients in skin fold management and structured skin care routines can help prevent intertrigo 2, 3.
- Using moisture-wicking textiles and keeping skin folds clean and dry can help reduce the risk of intertrigo 2, 3.
- Regular monitoring and follow-up with a healthcare provider can help ensure that intertrigo is properly managed and treated 2, 3.