From the Guidelines
Nystatin cream is effective for treating intertrigo when the condition is complicated by a Candida (yeast) infection. For intertrigo with fungal involvement, apply nystatin cream (100,000 units/g) to the affected areas 2-3 times daily for 7-14 days until the rash resolves, as supported by the guidelines for treatment of candidiasis 1. The cream should be applied to clean, dry skin, gently covering the entire affected area including skin folds. Nystatin works by binding to sterols in the fungal cell membrane, creating pores that lead to cell death of the Candida organisms.
However, nystatin is only effective against fungal components of intertrigo and will not address bacterial infections or the underlying skin-to-skin friction. For comprehensive treatment of intertrigo, combine nystatin with measures to keep the affected area dry, reduce friction with barrier creams, wear loose-fitting clothing, and maintain good hygiene, as recommended by the practice guidelines for the treatment of candidiasis 1. If the condition doesn't improve within two weeks, or if there are signs of bacterial infection (increased redness, warmth, pus), seek medical attention as additional treatments may be needed. Key considerations for treatment include:
- Keeping the infected area dry, especially in skin folds
- Using topical azoles and polyenes, including clotrimazole, miconazole, and nystatin, for fungal infections
- Addressing underlying conditions, such as obesity and diabetes, that may contribute to intertrigo
- Monitoring for signs of bacterial infection and seeking medical attention if necessary, as outlined in the guidelines 1.
From the Research
Effectiveness of Nystatin Cream in Intertrigo
- Nystatin cream is used in the treatment of intertrigo, particularly when caused by candidal infections 2.
- The medical treatment of candidal intertrigo usually requires topical administration of nystatin and azole group antifungals 2.
- A study on cutaneous candidiasis found that nystatin, clotrimazole, and miconazole were the most studied topical drugs and demonstrated similar efficacy with complete cure rates of 73%-100% 3.
- Although the studies provided do not directly assess the effectiveness of nystatin cream in intertrigo, they suggest that nystatin is effective in treating cutaneous candidiasis, which can cause intertrigo 3, 4, 5.
- It is essential to note that intertrigo can be caused by various factors, and the treatment should be tailored to the underlying cause 6.
Treatment Considerations
- The first and key step of management is identification and correction of predisposing factors, such as obesity, diabetes mellitus, and immunosuppressive conditions 2.
- Patients should be encouraged to lose weight, and intestinal colonization or periorificial infections should be medically managed, especially in recurrent and resistant cases 2.
- Topical therapies, including nystatin, can be effective in treating intertrigo, but systemic therapy may be required in cases of predisposing immunosuppressive conditions or generalized infections 2, 3.