What are the treatment guidelines for intertrigo?

Treatment Guidelines for Intertrigo

The primary treatment approach for intertrigo should focus on minimizing moisture and friction with absorptive powders such as cornstarch or barrier creams, along with appropriate antifungal therapy for secondary infections. 1

Diagnosis and Assessment

• Intertrigo is an inflammatory dermatosis of opposing skin surfaces caused by skin-on-skin friction

• Common locations include:

  • Inframammary folds
  • Axillae
  • Abdominal folds
  • Groin and perineum
  • Intergluteal folds
  • Toe and finger webs

• Assess for predisposing factors:

  • Obesity
  • Diabetes mellitus
  • Immunosuppressive conditions
  • Heat and humidity
  • Poor hygiene

Treatment Algorithm

Step 1: General Measures (All Patients)

• Keep affected areas clean and dry
• Use absorptive powders (cornstarch) or barrier creams
• Wear light, non-constricting, absorbent clothing
• Avoid wool and synthetic fibers
• Shower after physical exercise and thoroughly dry intertriginous areas
• Wear open-toed shoes for toe web intertrigo 1

Step 2: Identify and Treat Secondary Infections

For Candidal Intertrigo:

• First-line treatment: Topical antifungal agents 2, 3

  • Azoles (miconazole, clotrimazole) applied twice daily for 2-4 weeks
  • Nystatin applied 2-3 times daily for 2-4 weeks

• For resistant cases: Consider oral antifungal therapy

  • Fluconazole 400 mg (6 mg/kg) daily for 7-14 days 4
  • Continue treatment for 1-2 weeks after symptoms resolve

For Bacterial Intertrigo:

• Topical antibiotics or antiseptics based on culture results
• For extensive infection, consider systemic antibiotics

Step 3: Address Underlying Conditions

• Weight loss for obesity-related intertrigo
• Glycemic control for diabetic patients
• Appropriate management of immunosuppressive conditions
• Treatment of intestinal colonization or periorificial infections in recurrent cases 2

Special Considerations

For Recurrent Candidal Intertrigo:

• Investigate for undiagnosed diabetes or immunosuppression
• Consider maintenance therapy with weekly fluconazole (100-200 mg) for recurrent cases 4
• Evaluate for and treat possible sources of reinfection

For Severe or Widespread Disease:

• Consider systemic antifungal therapy:
  • Fluconazole 400 mg daily for 7-14 days
  • Itraconazole 200 mg daily for 7-14 days

Prevention Strategies

• Maintain good hygiene practices
• Use moisture-wicking fabrics
• Apply powder or barrier creams prophylactically in high-risk individuals
• Regular follow-up for patients with predisposing conditions

Treatment Duration

• Continue topical therapy for 1-2 weeks after clinical resolution to prevent recurrence 4
• For systemic therapy, treat for 7-14 days depending on severity and response

Monitoring

• Assess treatment response after 7-10 days
• If no improvement, consider culture and sensitivity testing
• For recurrent cases, investigate underlying systemic conditions

Common Pitfalls and Caveats

• Failure to identify and address predisposing factors leads to treatment failure
• Inadequate drying of affected areas can perpetuate the condition
• Premature discontinuation of treatment increases risk of recurrence
• Overuse of topical corticosteroids can worsen fungal infections
• Neglecting to treat all affected areas simultaneously can lead to reinfection

By following this structured approach to managing intertrigo, focusing on both the primary condition and any secondary infections, most cases can be effectively treated with significant improvement in patient comfort and quality of life.