What is the treatment for intertrigo?

Treatment of Intertrigo

Topical antifungal agents are the first-line treatment for candidal intertrigo, with keeping the affected area dry being equally important for successful resolution of the infection. 1

Diagnosis and Assessment

• Candidal intertrigo typically presents as erythematous patches in skin folds with peripheral scaling and satellite pustules
• Diagnosis is commonly made clinically based on characteristic appearance
• Confirmation can be obtained with potassium hydroxide (KOH) preparation when needed 2
• Examine all skin folds for involvement, particularly:
  • Axillary regions
  • Inframammary areas
  • Abdominal folds
  • Groin and perineum
  • Interdigital spaces

First-Line Treatment

Topical Antifungal Therapy

• Azole antifungals (apply 2-3 times daily for 1-2 weeks):
  • Clotrimazole cream - effective even in cases where patients failed to respond to nystatin 1
  • Miconazole - demonstrated lower relapse rates compared to nystatin 1
  • Other options: butoconazole, tioconazole, econazole 1, 2
• Polyene antifungals:
  • Nystatin cream or powder (apply 2-3 times daily) 1, 3

Critical Adjunctive Measures

• Keep affected areas clean and thoroughly dry 1, 4
  • Consider using a hair dryer on cool setting to dry skin folds completely
• Apply absorptive powders such as cornstarch to minimize moisture 4
• Use barrier creams to reduce friction between skin surfaces 4
• Wear light, non-constricting, absorbent clothing; avoid wool and synthetic fibers 4

For Cases with Significant Inflammation

• Consider combination therapy with antifungal and mild corticosteroid:
  • Isoconazole nitrate 1% with diflucortolone valerate 0.1% twice daily for 7 days 1
• This approach helps address both the fungal infection and inflammatory component

For Resistant or Extensive Cases

• Increase azole dosage or frequency of application 1
• Consider oral fluconazole (150 mg single dose or weekly for recurrent cases) 1, 2
• For bacterial superinfections:
  • Secondary streptococcal infections: topical mupirocin or oral penicillin 2
  • Corynebacterium infections: oral erythromycin 2

Treatment Duration

• Continue treatment until complete healing (typically 1-2 weeks) 1
• Longer treatment courses may be needed in resistant cases or in obese or diabetic patients 1
• Do not stop treatment when symptoms merely improve; continue until full resolution 1

Management of Predisposing Factors

• Address underlying conditions:
  • Optimize glycemic control in diabetic patients 1, 3
  • Encourage weight loss for obese patients 1, 3
  • Treat any periorificial infections or intestinal colonization 3
• Consider treating sexual partners with antifungal cream to prevent reinfection 1

Prevention of Recurrence

• Maintain good hygiene practices in skin fold areas 5
• Shower after physical exercise and thoroughly dry intertriginous areas 4
• Consider moisture-wicking textiles within skin folds to reduce skin-on-skin friction 5
• Regular use of absorptive powders in susceptible areas 4
• For toe web intertrigo, wearing open-toed shoes can be beneficial 4

Special Populations

• Pregnancy: Use only topical azole therapy; avoid oral antifungals like fluconazole due to potential teratogenic effects 1
• Immunocompromised patients: May require longer treatment courses or systemic therapy 3

Common Pitfalls to Avoid

• Inadequate drying of affected areas leading to treatment failure 1
• Insufficient treatment duration resulting in recurrence 1
• Failure to address underlying conditions (diabetes, obesity) 1, 3
• Misdiagnosis - confirm with KOH preparation when clinical presentation is atypical 1
• Development of resistance with prolonged or repeated courses of antifungal therapy 1

By following this structured approach to treatment and addressing both the infection and contributing factors, most cases of intertrigo can be effectively managed with significant improvement in patient comfort and quality of life.