From the Guidelines
Intertrigo is best managed with topical azoles and polyenes, such as clotrimazole, miconazole, and nystatin, along with keeping the area dry, as recommended by the Infectious Diseases Society of America 1. To effectively manage intertrigo, it's crucial to address the underlying causes, which include moisture, friction, and secondary infections in skin fold areas.
- Keeping the affected skin folds clean, dry, and well-ventilated is essential, and this can be achieved by gently washing with mild soap and thoroughly drying the area.
- The use of absorbent powders like zinc oxide or cornstarch can also help in keeping the area dry.
- For fungal infections, which are common in intertrigo, especially in obese and diabetic patients, topical antifungals such as clotrimazole, miconazole, and nystatin are effective, as noted in the practice guidelines for the treatment of candidiasis by the Infectious Diseases Society of America 1.
- Additionally, lifestyle modifications play a significant role in the management and prevention of intertrigo, including weight loss if appropriate, wearing loose-fitting cotton clothing, and changing out of wet clothes promptly.
- Barrier products like zinc oxide paste can be used in skin folds to prevent friction and moisture accumulation.
- It's also important to note that while bacterial infections may require topical antibiotics, and inflammation may be treated with low-potency topical corticosteroids, the primary approach should focus on addressing the fungal infection and maintaining dryness, as emphasized by the guidelines 1.
- Severe or persistent cases may require further evaluation and treatment, potentially including oral antifungals or antibiotics, but the initial management should prioritize topical treatments and preventive measures.
From the Research
Management of Intertrigo
The management of intertrigo involves a combination of strategies to reduce skin-on-skin friction, prevent moisture accumulation, and treat secondary infections. Some key approaches include:
- Identifying and addressing predisposing factors, such as obesity, and educating patients on how to reduce these factors 2
- Implementing a structured skin care routine and educating patients on skin fold management 2, 3
- Using moisture-wicking textiles within skin folds to reduce friction and moisture accumulation 2
- Treating secondary infections with appropriate topical agents, such as antifungal medications like clotrimazole, nystatin, and miconazole 4
Treatment of Secondary Infections
Secondary infections, such as cutaneous candidiasis, are common in intertrigo and require prompt treatment. Topical antifungal medications, such as clotrimazole, nystatin, and miconazole, have been shown to be effective in treating these infections 4. In some cases, systemic therapy with oral fluconazole may be necessary 4.
Prevention and Education
Preventing intertrigo and its complications requires patient education on skin care and skin fold management. Healthcare professionals should provide clear guidance on how to reduce predisposing factors, manage skin folds, and prevent moisture accumulation 2, 3. By investing in the development and adoption of clear skin care and skin fold management protocols, healthcare professionals can improve patient outcomes and reduce the risk of intertrigo and its complications 3.