What is the treatment for intertrigo?

Treatment of Intertrigo: Medical Description and Management

Intertrigo should be treated with a combination of moisture reduction, topical antifungals for fungal infections, and appropriate antibiotics for bacterial superinfections, along with addressing underlying predisposing factors to prevent recurrence. 1, 2, 3

Definition and Clinical Presentation

Intertrigo is a superficial inflammatory dermatitis that occurs on two closely opposed skin surfaces due to:

• Moisture accumulation
• Friction between skin folds
• Poor ventilation
• Exacerbation by bodily secretions (sweat, urine, feces)

Physical examination reveals:

• Erythematous patches in skin folds
• Peripheral scaling
• Possible maceration and erosions
• Satellite lesions (suggestive of candidal infection)

Diagnostic Approach

• Clinical diagnosis: Based on characteristic appearance of inflamed skin folds
• Potassium hydroxide (KOH) preparation: To confirm fungal elements, especially Candida
• Bacterial culture: For suspected bacterial superinfection
• Wood lamp examination: May help identify certain bacterial infections (e.g., Corynebacterium)

Treatment Algorithm

1. Primary Management (All Cases)

• Reduce moisture and friction:
  • Keep affected areas clean and thoroughly dry 4, 2
  • Use absorptive powders (cornstarch) or barrier creams 2
  • Wear light, non-constricting, absorbent clothing 2
  • Avoid wool and synthetic fibers 2
  • Use moisture-wicking textiles within skin folds 3

2. For Candidal Intertrigo

• First-line: Topical azole antifungals 4, 1

  • Clotrimazole cream 1% applied 2-3 times daily for 14 days
  • Miconazole cream 2% applied 2-3 times daily for 14 days
  • Ketoconazole cream 2% applied 2-3 times daily for 14 days
  • Continue until 7 days after clinical resolution

• Alternative topical options:

  • Nystatin cream or powder applied 2-3 times daily 1, 5
  • Econazole or oxiconazole cream applied as directed 1

• For resistant cases:

  • Oral fluconazole 200-400 mg daily for 7-14 days 4, 1
  • Itraconazole 200 mg daily for resistant species 4

3. For Bacterial Superinfections

• Streptococcal infections:

  • Topical mupirocin ointment applied 3 times daily 1
  • Or oral penicillin for more extensive infection 1

• Corynebacterium infections:

  • Oral erythromycin 1

• For other bacterial infections:

  • Appropriate topical or systemic antibiotics based on culture results

4. For Mixed Infections

• Combination therapy with both antifungal and antibacterial agents may be necessary

Prevention of Recurrence

• Address underlying conditions:

  • Weight loss for obesity 2, 5
  • Glycemic control for diabetes 5
  • Management of immunosuppressive conditions 5

• Lifestyle modifications:

  • Shower after exercise and thoroughly dry intertriginous areas 2
  • Wear open-toed shoes for toe web intertrigo 2
  • Educate patients about precautions regarding heat and humidity 2
  • Establish structured skin care routine 3

• For recurrent candidal intertrigo:

  • Consider treating intestinal colonization or periorificial infections 5
  • Evaluate for systemic conditions predisposing to recurrence 5

Special Considerations

• HIV-infected patients: May require longer treatment courses and antiretroviral therapy to reduce recurrence risk 4

• Monitoring: Evaluate response within 7 days of starting treatment; seek further evaluation if condition worsens, spreads, or if systemic symptoms develop 4

• Caution: Avoid irritant antiseptics that may aggravate intertrigo or provoke allergic contact dermatitis 6

Treatment Pitfalls to Avoid

• Failing to address underlying predisposing factors
• Inadequate drying of affected areas
• Premature discontinuation of antifungal therapy
• Missing bacterial superinfection
• Not considering systemic therapy for extensive or resistant cases
• Overlooking the need for maintenance therapy in recurrent cases

By following this comprehensive approach to intertrigo management, focusing on both treatment of the acute condition and prevention of recurrence, patients can achieve significant improvement in symptoms and quality of life.