What is the recommended treatment for intertrigo?

From the Guidelines

The most effective treatment for intertrigo involves keeping the affected area clean, dry, and applying topical antifungals such as clotrimazole, miconazole, or nystatin, as recommended by the Infectious Diseases Society of America 1. To manage intertrigo, it is essential to address the underlying causes of the condition, including moisture, friction, and secondary infections in skin folds.

• Keeping the area dry is crucial, and this can be achieved by gently washing the affected skin folds with mild soap and patting them dry thoroughly.
• Applying barrier creams like zinc oxide or petroleum jelly can help protect the skin and reduce friction.
• For mild cases, over-the-counter antifungal creams containing clotrimazole, miconazole, or terbinafine can be applied twice daily for 2-4 weeks.
• If a bacterial infection is present, topical antibiotics like mupirocin may be necessary, while prescription antifungals such as ketoconazole cream or oral fluconazole might be needed for fungal infections.
• Lifestyle modifications, including weight loss if appropriate, wearing loose-fitting cotton clothing, and changing out of wet clothes promptly, are also vital in managing intertrigo, as noted in guidelines for treating candidiasis 1. The goal of these treatments is to reduce moisture, friction, and microbial growth in skin folds, thereby alleviating the symptoms of intertrigo and improving the patient's quality of life.

From the Research

Intertrigo Treatment

The recommended treatment for intertrigo involves a combination of measures to reduce moisture, friction, and infection.

• Identify and educate patients on reducing predisposing factors such as moisture and friction 2
• Adopt a structured skin care routine and manage skin folds to prevent moisture accumulation 2, 3
• Use moisture-wicking textiles within skin folds to reduce skin-on-skin friction and wick away moisture 2
• Treat secondary infections with appropriate topical agents, such as:
  • Antifungals (e.g., nystatin, clotrimazole, ketoconazole, oxiconazole, or econazole) for fungal infections 4
  • Antibiotics (e.g., mupirocin or oral penicillin) for bacterial infections 4
  • Antiseptics for bacterial or fungal infections 5, 6
• Consider surgical interventions, such as reduction mammaplasty, for severe cases of intertrigo, particularly in the inframammary area 6

Secondary Infection Treatment

Secondary infections, such as candidal intertrigo, can be treated with:

• Topical antifungals (e.g., nystatin, clotrimazole, ketoconazole, oxiconazole, or econazole) 4
• Oral fluconazole for resistant cases 4
• Topical mupirocin or oral penicillin for streptococcal infections 4
• Oral erythromycin for Corynebacterium infections 4

Prevention

Preventing intertrigo involves reducing moisture, friction, and infection in skin folds.

• Educate patients on skin fold management and structured skin care routines 2, 3
• Use moisture-wicking textiles within skin folds to reduce skin-on-skin friction and wick away moisture 2
• Maintain good hygiene and dryness in skin folds to prevent infection 3