From the Guidelines
For a 10-month-old infant with refractory intertrigo that hasn't responded to Nystatin, I strongly recommend switching to a combination approach using a low-potency topical steroid such as hydrocortisone 1% cream applied thinly twice daily for 5-7 days, along with an antifungal-antibacterial combination like clotrimazole-betamethasone cream. This approach is based on the principle of addressing potential resistant fungal infection, bacterial involvement, or underlying inflammation that may not have been adequately managed by Nystatin alone 1. Keeping the affected skin folds clean and dry is crucial, as emphasized in guidelines for treating candidiasis, which includes intertrigo 1.
Key Considerations:
- The previous Nystatin treatment failure suggests the need for a broader therapeutic approach.
- A short course of low-potency steroid can reduce inflammation without significant side effects.
- Antifungal-antibacterial combinations can address both fungal and bacterial elements of the infection.
- Barrier creams containing zinc oxide can protect the skin and aid in healing.
Management Strategy:
- Apply hydrocortisone 1% cream thinly twice daily for 5-7 days.
- Use an antifungal-antibacterial combination like clotrimazole-betamethasone cream.
- Keep the skin folds clean and dry, washing gently with warm water and mild soap.
- Apply barrier creams containing zinc oxide after each diaper change.
- Ensure frequent diaper changes and avoid tight clothing to prevent moisture trapping.
Follow-Up:
If no improvement occurs within 7 days, or if the condition worsens, the infant should be reevaluated. A bacterial culture or a different treatment approach may be necessary to ensure the best outcome for the infant 1.
From the FDA Drug Label
INDICATIONS AND USAGE Nystatin Topical Powder is indicated in the treatment of cutaneous or mucocutaneous mycotic infections caused by Candida albicans and other susceptible Candida species. The FDA drug label does not answer the question.
From the Research
Refractory Intertrigo Treatment
The recommended treatment for a 10-month-old infant with refractory intertrigo previously treated with Nystatin is not directly addressed in the provided studies. However, some studies offer insights into the treatment of intertrigo and skin infections:
- Intertrigo is a common inflammatory skin disorder caused by skin-on-skin friction within skin folds, as a result of moisture becoming trapped because of poor air circulation 2, 3.
- The aim of treatment is to reduce moisture, prevent friction, and treat any secondary infections 3.
- Topical antibiotics such as mupirocin, fusidic acid, and bacitracin can be used to treat bacterial skin infections, but their use should be judicious to avoid resistance and sensitization 4, 5.
- For intertrigo, consider using moisture-wicking textiles within skin folds to reduce skin-on-skin friction, wick away moisture, and reduce secondary infection 3.
- Educating patients in skin fold management and adopting a structured skin care routine can also help in managing intertrigo 3.
Considerations for Refractory Intertrigo
In cases of refractory intertrigo, it may be necessary to:
- Identify and address predisposing factors such as obesity or poor air circulation 2, 3.
- Consider alternative treatments such as topical corticosteroids or calcineurin inhibitors, although these may not be suitable for all patients, especially infants 6.
- Consult with a healthcare professional to determine the best course of treatment for the individual patient.
Key Points
- Intertrigo is a common inflammatory skin disorder caused by skin-on-skin friction within skin folds.
- Treatment aims to reduce moisture, prevent friction, and treat any secondary infections.
- Topical antibiotics and moisture-wicking textiles can be used to manage intertrigo.
- Educating patients in skin fold management and adopting a structured skin care routine is crucial in managing intertrigo 2, 3.