From the Guidelines
For intertrigo, I recommend using pimecrolimus 0.1% cream, a topical calcineurin inhibitor, as it has shown efficacy in treating intertriginous psoriasis and can be used as a steroid-sparing agent for prolonged use. This recommendation is based on the most recent and highest quality study available, which demonstrated that 71% of patients with intertriginous psoriasis were clear or almost clear after 8 weeks of twice-daily treatment with pimecrolimus 0.1% cream 1.
Treatment Approach
When treating intertrigo, it's essential to keep the area clean and dry, washing gently with mild soap and water, then thoroughly drying before applying medications.
- Apply pimecrolimus 0.1% cream twice daily to the affected areas
- Consider using absorbent powders like zinc oxide or cornstarch to keep skin folds dry
- Wear loose-fitting clothing and change out of wet clothes promptly to prevent moisture accumulation
Alternative Options
Although pimecrolimus 0.1% cream is the recommended treatment, alternative options like clotrimazole 1% or miconazole 2% cream, along with hydrocortisone 1% cream for inflammation, can be considered based on older guidelines 1. However, these options may not be as effective as pimecrolimus 0.1% cream in treating intertrigo, especially in cases where steroid-sparing agents are preferred.
Prevention
Prevention is crucial in managing intertrigo, and patients should be advised to:
- Keep skin folds dry using absorbent powders
- Wear loose-fitting clothing
- Change out of wet clothes promptly
- Avoid skin-on-skin friction in moist areas to prevent inflammation and microbial overgrowth.
From the Research
Treatment Options for Intertrigo
- Topical antifungal agents such as nystatin, clotrimazole, ketoconazole, oxiconazole, or econazole can be used to treat fungal lesions 2
- For secondary streptococcal infections, topical mupirocin or oral penicillin can be used 2
- Corynebacterium infections can be treated with oral erythromycin 2
- Clotrimazole, nystatin, and miconazole have been shown to be effective topical treatments for cutaneous candidiasis, with complete cure rates of 73%-100% 3
Management and Prevention of Intertrigo
- Identifying and educating patients on reducing predisposing factors can help prevent intertrigo 4
- Adopting a structured skin care routine and using moisture-wicking textiles within skin folds can help reduce skin-on-skin friction and prevent secondary infection 4
- Investing in the development and adoption of clear skin care and skin fold management protocols can lead to improvements in patient experience and better clinical outcomes 5
Creams for Intertrigo
- Clotrimazole cream has been shown to be as effective as nystatin in cutaneous candidiasis and as effective as Whitfield's ointment and tolnaftate in the treatment of dermatophytoses 6
- Topical creams such as clotrimazole, nystatin, and miconazole can be used to treat intertrigo, with similar efficacy and mild adverse effects 3