Medical Term: Intertrigo
The medical term for a rash underneath the breast and abdominal folds is "intertrigo." 1, 2
Definition and Pathophysiology
Intertrigo is a superficial inflammatory dermatitis that occurs on two closely opposed skin surfaces as a result of moisture, friction, and lack of ventilation 3, 4. This condition develops when skin-on-skin friction in skin folds traps moisture due to poor air circulation, creating an inflammatory response 1, 2.
Common Locations
The most frequently affected areas include:
- Inframammary folds (beneath the breasts)
- Abdominal folds (pannus)
- Inguinal region (groin)
- Gluteal cleft
- Axillary region (armpits)
- Umbilical area
Clinical Presentation
The primary features of intertrigo include:
- Erythema (redness) with peripheral scaling
- Maceration of the skin
- Moisture and exudate in affected folds
- The skin is often inflamed but may or may not be eroded 5
Secondary Infections
A critical pitfall is failing to recognize secondary infections, which commonly complicate intertrigo. The breakdown of the skin barrier creates entry points for:
- Candidal infection (most common fungal): presents with satellite lesions 3
- Bacterial infections: including Staphylococcus aureus, group A beta-hemolytic streptococcus, and Corynebacterium minutissimum 3
- Gram-negative bacteria: particularly Pseudomonas aeruginosa in toe web intertrigo 6, 7
Treatment Approach
For uncomplicated candidal intertrigo (the most common secondary infection), topical azoles or polyenes are effective 8, 9:
- Clotrimazole
- Miconazole
- Nystatin
Keeping the infected area dry is equally important as topical therapy 8, 9.
For bacterial superinfections:
- Topical mupirocin for streptococcal infections
- Oral erythromycin for Corynebacterium 3
- Oral penicillin for streptococcal infections 3
For resistant candidal cases, oral fluconazole may be required 3.
Risk Factors
Key predisposing factors include:
- Obesity (strongly associated) 2
- Diabetes mellitus (OR 1.8 for inguinal intertrigo) 5
- Urinary incontinence (OR 2.9 for gluteal cleft) 5
- High BMI 5
- Female sex 5
- Poor hygiene and moisture control
Prevention Strategies
- Identify and reduce predisposing factors
- Keep skin folds clean and thoroughly dry
- Use absorptive powders (cornstarch) or barrier creams 4
- Wear light, nonconstricting, absorbent clothing; avoid wool and synthetic fibers 4
- Consider moisture-wicking textiles within skin folds 1
- Shower after physical activity and dry intertriginous areas thoroughly 4
The evidence base for intertrigo management remains limited, with most recommendations based on expert consensus rather than high-quality trials 1. However, the fundamental principles of moisture control, friction reduction, and treatment of secondary infections are consistently supported across the literature.