What is the treatment for intertrigo?

Treatment of Intertrigo

The treatment of intertrigo requires addressing the underlying causes while managing secondary infections, with topical antifungals being first-line therapy for fungal intertrigo and topical antibiotics for bacterial intertrigo. 1

Diagnosis and Assessment

• Examine skin folds for:

  • Erythema with peripheral scaling
  • Satellite lesions (suggestive of Candida)
  • Presence of exudate and malodor (suggestive of bacterial infection)
  • Maceration and skin breakdown

• Confirm diagnosis with:

  • KOH preparation to identify fungal elements
  • Bacterial or fungal cultures for persistent cases
  • Wood lamp examination for bacterial superinfections 1, 2

Treatment Algorithm

Step 1: Address Underlying Factors

• Keep affected areas clean and dry
• Use absorptive powders (cornstarch) or barrier creams
• Recommend light, nonconstricting, absorbent clothing
• Avoid wool and synthetic fibers 3

Step 2: Treat Based on Causative Agent

For Candidal Intertrigo:

• First-line: Topical antifungals
  • Miconazole
  • Clotrimazole
  • Ketoconazole
  • Oxiconazole
  • Econazole
  • Nystatin 1, 2
• For resistant cases: Oral fluconazole 2

For Bacterial Intertrigo:

• Topical antibiotics effective against Gram-positive bacteria
• For streptococcal infections: Topical mupirocin or oral penicillin
• For Corynebacterium infections: Oral erythromycin
• For suspected MRSA: Antibiotics based on local resistance patterns 1, 2

Step 3: For Mixed Infections

• Combination therapy with antifungal and antibacterial agents
• Consider combination products containing both components 4

Special Considerations

For Recurrent Cases:

1. Identify and correct predisposing factors:

   • Weight loss for obese patients
   • Optimal glycemic control for diabetic patients
   • Treatment of underlying immunosuppressive conditions 4

2. Consider:

   • More potent systemic antifungals for resistant fungal infections
   • Investigation of intestinal colonization or periorificial infections
   • Longer treatment courses 4

Prevention Strategies

• Regular skin fold hygiene and inspection
• Thorough drying after bathing or exercise
• Use of moisture-wicking textiles within skin folds to reduce friction
• Wearing open-toed shoes for toe web intertrigo 1, 3, 5

Common Pitfalls to Avoid

1. Inadequate treatment duration - continue treatment even if symptoms improve quickly
2. Failure to address underlying conditions (diabetes, obesity, immunosuppression)
3. Using irritant antiseptics that may aggravate intertrigo or provoke allergic contact dermatitis 6
4. Not confirming the causative agent in resistant cases
5. Overlooking the importance of mechanical factors (friction, moisture, lack of ventilation) in management 3, 5

By following this structured approach to treating intertrigo, focusing on both the underlying causes and any secondary infections, most cases can be effectively managed and recurrence prevented.