What is the best topical treatment for intertrigo in a patient with dementia in a Long-Term Care (LTC) setting?

From the Guidelines

For intertrigo in a patient with dementia in long-term care, I recommend using a topical azole, such as clotrimazole, as it is effective against candidal skin infections, which are common in intertrigo, as stated in the practice guidelines for the treatment of candidiasis by the Infectious Diseases Society of America 1. When managing intertrigo in this setting, it's crucial to consider the patient's comfort and the practicality of the treatment regimen for caregivers. Key aspects of treatment include:

• Keeping the affected area dry, as moisture exacerbates intertrigo
• Using a topical antifungal, such as clotrimazole, which is effective against common fungal infections in skin folds, as noted in the guidelines 1
• Avoiding harsh soaps and ensuring gentle cleansing with a pH-balanced cleanser
• Considering the use of a barrier cream to protect the skin and reduce friction, especially in skin folds
• Implementing a simple and consistent treatment regimen that caregivers can easily follow in a long-term care setting Given the potential for fungal infections in intertrigo, as highlighted by the Infectious Diseases Society of America's guidelines 1, the use of a topical azole like clotrimazole is a reasonable choice, balancing efficacy with the need for a straightforward treatment regimen in a long-term care setting.

From the FDA Drug Label

Adults and children 2 years of age and older: apply to the affected area no more than 3 to 4 times daily The best topical treatment for intertrigo in a patient with dementia in a Long-Term Care (LTC) setting is not explicitly stated in the provided drug label.

• Fusidic acid may be considered as a treatment option, but its effectiveness for intertrigo is not directly mentioned in the label.
• The label only provides general application instructions for fusidic acid, without specifying its use for intertrigo or its suitability for patients with dementia in an LTC setting 2.

From the Research

Topical Treatment for Intertrigo in Patients with Dementia

There are no specific studies that directly address the best topical treatment for intertrigo in patients with dementia in a Long-Term Care (LTC) setting. However, some general information can be gathered from the available evidence:

• Intertrigo is an inflammatory dermatosis of the skin folds of the body, for which a large variety of topical medications may be recommended 3.
• A systematic literature review on preventing and treating intertrigo found that most studies concerned treatments with antifungals or disinfectants, but the methodologic quality of the studies was poor and provided no scientific evidence for any type of nursing prevention or treatment strategy 3.
• In the context of LTC settings, studies have focused on palliative care interventions for people with dementia, addressing symptom management, avoiding overly aggressive treatment, and education 4.
• Barriers to treatment of hallucinations and delusions in people with dementia residing in LTC facilities include delayed recognition of symptoms, reluctance of staff and family members to acknowledge psychiatric issues, and lack of approved pharmacotherapies 5.
• Supporting self-care of long-term conditions in people with dementia is important, and factors that facilitate or inhibit self-management and management by a proxy have been identified, including simplifying routines, negotiating self-management support, and interface with professionals 6.
• General care for patients with dementia in LTC settings includes the efficacy of cholinesterase inhibitors and memantine, optimal environment for maintenance of function, treatment of depression and agitation, and evaluation and management of eating problems 7.

Considerations for Topical Treatment

When considering topical treatment for intertrigo in patients with dementia in an LTC setting, the following factors should be taken into account:

• The patient's ability to manage their own care and the need for assistance from caregivers
• The potential for skin irritation or allergic reactions to topical medications
• The importance of maintaining a clean and dry environment to prevent the spread of infection
• The need for education and support for caregivers to manage the patient's skin care and recognize potential complications.