From the Guidelines
The primary treatment for intertrigo involves keeping the affected area clean, dry, and exposed to air, with the use of topical calcineurin inhibitors such as tacrolimus or pimecrolimus being especially helpful in intertriginous areas. Here's a comprehensive approach:
- Cleanse the area gently with mild soap and water, then pat dry thoroughly.
- Apply a barrier cream or ointment such as zinc oxide or petroleum jelly to protect the skin.
- For mild cases, use an over-the-counter antifungal cream like clotrimazole 1% or miconazole 2%, applied twice daily for 2-4 weeks, as suggested by 1.
- If there's significant inflammation, use a low-potency topical corticosteroid like hydrocortisone 1% cream for up to 7 days.
- For bacterial involvement, apply mupirocin 2% ointment three times daily for 7-10 days.
- In severe or persistent cases, oral antifungals like fluconazole 150 mg weekly for 2-4 weeks may be necessary.
- Prevent recurrence by keeping the area dry, using moisture-wicking fabrics, and applying antiperspirants to skin folds. The use of topical calcineurin inhibitors is supported by recent studies, such as 1, which found that pimecrolimus and tacrolimus are effective in treating intertriginous psoriasis. Additionally, 1 suggests that calcineurin inhibitors can be used as steroid-sparing agents for prolonged use. This regimen addresses the primary causes of intertrigo: moisture, friction, and microbial overgrowth, and is in line with the most recent and highest quality study available, 1.
From the Research
Treatment Options for Intertrigo
The treatment for intertrigo (intertriginous dermatitis) involves a combination of measures to reduce inflammation, prevent infection, and manage symptoms. Some of the treatment options include:
- Topical antifungal agents, such as nystatin and azole group antifungals, to treat candidal intertrigo 2, 3
- Topical corticosteroids, such as 1% hydrocortisone cream, to reduce inflammation, although they may exacerbate Candida infections 4
- Adsorbent lotions containing ingredients such as tapioca starch, spent grain wax, and aloe barbadensis, which have been shown to be effective in reducing symptoms and promoting healing 4
- Moisture-wicking textiles to reduce skin-on-skin friction and prevent secondary infection 5
- Structured skin care routines and patient education on skin fold management to prevent recurrence 5
Management of Predisposing Factors
It is essential to identify and correct predisposing factors, such as:
- Obesity, diabetes mellitus, and immunosuppressive conditions, which can facilitate the occurrence and recurrence of intertrigo 2, 5
- Poor air circulation and trapped moisture, which can contribute to the development of intertrigo 5
Medical Treatment
Medical treatment of intertrigo usually requires topical administration of antifungal agents, and in some cases, systemic agents may be necessary, especially in cases of predisposing immunosuppressive conditions or generalized infections 2, 3. The treatment should be tailored to the individual needs of the patient, taking into account the type, location, and surface area of the infection, as well as patient age, degree of inflammation, and underlying comorbidities 6.