What is the treatment approach for intertrigo diagnosed with a Woods (Wood's lamp)?

Treatment of Intertrigo Diagnosed with Wood's Lamp

For intertrigo with candidal infection confirmed by Wood's lamp examination, first-line treatment is topical antifungal therapy with nystatin, clotrimazole, ketoconazole, oxiconazole, or econazole, applied twice daily for 1-2 weeks. 1

Diagnostic Confirmation with Wood's Lamp

Wood's lamp examination is particularly useful for diagnosing certain fungal infections:

• Candidal infections fluoresce with a blue-white or yellow-green color
• The lamp helps differentiate between candidal intertrigo and other causes
• Confirmation can be supplemented with potassium hydroxide (KOH) preparation if needed 1

Treatment Algorithm for Intertrigo

Step 1: Primary Management

• Keep the affected area clean and dry
• Use absorptive powders (cornstarch) or barrier creams to minimize moisture and friction 2
• Ensure proper ventilation of skin folds
• Recommend light, non-constricting, absorbent clothing (avoid wool and synthetic fibers) 2

Step 2: Antifungal Treatment for Candidal Intertrigo

• First-line topical options:

  • Nystatin cream/ointment applied twice daily
  • Azole antifungals: clotrimazole, ketoconazole, oxiconazole, or econazole applied twice daily 1
  • Continue treatment for 1-2 weeks after symptoms resolve to prevent recurrence 3

• For resistant cases:

  • Oral fluconazole 200-400 mg daily for 7-14 days 1, 3
  • Consider posaconazole for refractory cases 3

Step 3: Management of Secondary Bacterial Infections

If bacterial superinfection is present:

• For streptococcal infections: topical mupirocin or oral penicillin 1
• For Corynebacterium infections: oral erythromycin 1

Prevention of Recurrence

1. Address underlying predisposing factors:

   • Weight loss for obesity
   • Glycemic control for diabetes
   • Management of immunosuppressive conditions 4

2. Maintenance measures:

   • Regular cleansing and thorough drying of affected areas
   • Use of moisture-wicking textiles within skin folds 5
   • Consider prophylactic use of antifungal powders in recurrent cases

3. Lifestyle modifications:

   • Shower after physical exercise
   • Wear open-toed shoes for toe web intertrigo 2
   • Avoid excessive heat and humidity

Special Considerations

• For extensive or recurrent infections, investigate for underlying conditions such as diabetes or immunosuppression
• For treatment-resistant cases, perform culture and sensitivity testing to identify specific pathogens 4
• Consider intestinal colonization as a source of recurrent candidal infections 4

Treatment Monitoring

• Evaluate clinical response after 7-10 days of treatment
• If no improvement, consider alternative diagnoses or resistant organisms
• For persistent cases, consider longer treatment courses or combination therapy

The most recent evidence emphasizes the importance of addressing both the fungal infection and the underlying environmental factors that promote intertrigo to achieve successful treatment and prevent recurrence 5.