From the Guidelines
Management of skin fold issues in obese patients should prioritize a comprehensive approach focusing on hygiene, moisture control, and prevention of infection, as outlined in recent guidelines 1. The most effective strategy for managing skin fold issues in obese patients involves daily cleansing of skin folds with gentle, pH-balanced cleansers, followed by thorough but gentle drying. Key interventions include:
- Applying moisture-wicking products like zinc oxide cream, antifungal powders (such as miconazole or clotrimazole), or barrier creams to prevent maceration and reduce friction.
- Using topical antifungals like clotrimazole 1% or miconazole 2% for established fungal infections, applied twice daily for 2-4 weeks.
- Employing topical antibiotics such as mupirocin 2% ointment three times daily for 7-10 days, or oral antibiotics for more severe bacterial infections.
- Managing intertrigo with low-potency corticosteroids like hydrocortisone 1% cream for short periods (5-7 days) to reduce inflammation.
- Utilizing moisture-absorbing fabrics, breathable cotton clothing, and the use of soft cloths or silicone-based sheets between skin folds to reduce friction. These interventions are supported by the most recent and highest quality study available 1, which emphasizes the importance of a multidisciplinary approach to obesity management, including addressing skin fold issues. Additionally, maintaining a dry environment and using effective topical treatments, as recommended in earlier guidelines 1, remain crucial in preventing and managing skin fold infections. Weight management, as suggested in 1 and 1, is also essential for reducing the risk of skin fold issues in obese patients, and a multidisciplinary collaborative care approach should be used where possible to support and maintain weight loss 1.
From the Research
Management of Skin Fold Issues in Obese Patients
The management of skin fold issues in obese patients is crucial to prevent complications such as skin infections and delayed wound healing.
- Skin fold issues in obese patients are often caused by skin-on-skin friction, moisture, and limited air circulation, leading to intertrigo, a superficial inflammatory skin disorder 2.
- Intertrigo can lead to secondary cutaneous infections, making it essential to manage the condition promptly.
- Maintaining skin hygiene, particularly between skin folds, is a challenge for patients with bariatric needs, and there is a gap in the evidence base for skin hygiene in this population 3.
Prevention and Treatment of Skin and Soft Tissue Infections
Prevention and treatment of skin and soft tissue infections (SSTIs) in obese patients require optimized antimicrobial usage.
- SSTIs are prevalent in the obese population, and the characterization of antibiotics in this population is not a regulatory mandate, making it challenging to optimize dosing regimens 4.
- Therapeutic drug monitoring is essential for optimizing antimicrobial usage in obese patients, particularly for vancomycin and teicoplanin 4.
- Certain antibiotics, such as oxazolidinones, daptomycin, and lipoglycopeptides, have shown promise in the management of SSTIs in obese patients 4.
Effects of Obesity on Skin Infections and Wound Healing
Obesity has a significant impact on skin infections and wound healing.
- Obesity increases the risk of skin infections, including fungal and bacterial infections, and alters the skin microbiome 5.
- Obesity also affects wound healing, with immune cells playing a crucial role in the process 5.
- Further research is needed to characterize the cellular and molecular mechanisms involved in the effects of obesity on wound healing and to identify specific targets for intervention 5.
Antimicrobial Dosing Recommendations for Obese Patients
Antimicrobial dosing recommendations for obese patients are essential to ensure effective treatment and prevent toxicity.
- Pathophysiological changes in obese patients lead to pharmacokinetic and pharmacodynamic alterations, requiring adjusted antimicrobial dosing 6.
- A comprehensive review of antimicrobial dosing in obese patients highlights the need for critically assessed literature on pharmacokinetics and possible dosing strategies 6.