What is the recommended treatment for intertrigo?

Treatment of Intertrigo

For intertrigo, the recommended treatment is topical azole antifungals such as clotrimazole cream 1% applied 2-3 times daily for 14 days, with keeping the affected area clean and dry as an essential component of management. 1

Primary Management Approach

First-Line Treatment

• Topical antifungal therapy:
  • Clotrimazole cream 1% applied 2-3 times daily for 14 days 1
  • Alternative topical azoles: miconazole cream 2% or ketoconazole cream 2%, applied 2-3 times daily for 14 days 1
  • Continue treatment until 7 days after clinical resolution to prevent relapse

Essential Adjunctive Measures

• Keep affected areas clean and dry 1, 2
• Use absorptive powders such as cornstarch or barrier creams to minimize moisture and friction 2
• Wear light, nonconstricting, and absorbent clothing; avoid wool and synthetic fibers 2
• For toe web intertrigo, wearing open-toed shoes can be beneficial 2

Management of Secondary Infections

Candidal Intertrigo

• For mild to moderate candidal infection:
  • Topical azole antifungals as mentioned above 1
• For extensive or resistant candidal infections:
  • Oral fluconazole 200-400 mg daily for 7-14 days 1
  • Alternative: itraconazole 200 mg daily 1

Bacterial Superinfection

• For suspected bacterial involvement:
  • Topical antiseptics or antibiotics depending on the pathogens 2
  • For severe cases, consider systemic antibiotics based on culture results

Special Considerations

Resistant Cases

• For fluconazole-resistant species (e.g., C. glabrata):
  • Topical boric acid 600 mg in gelatin capsules applied daily for 14 days 1
• For recurrent cases:
  • Investigate and treat intestinal colonization or periorificial infections 3
  • Consider longer treatment courses or maintenance therapy 3

Immunocompromised Patients

• HIV-infected patients may require longer courses of treatment 1
• Consider systemic antifungal therapy with newer agents for immunosuppressed patients 3

Prevention of Recurrence

Addressing Underlying Factors

• Weight loss for obese patients 3, 4
• Proper glycemic control for diabetic patients 3
• Regular follow-up for patients with endocrine disorders 3

Daily Preventive Measures

• Adopt structured skin care routine 4
• Shower after physical exercise and thoroughly dry intertriginous areas 2
• Consider using moisture-wicking textiles within skin folds to:
  • Reduce skin-on-skin friction
  • Wick away moisture
  • Reduce secondary infection 4

Monitoring and Follow-up

• Evaluate response within 7 days of starting treatment 1
• Seek further evaluation if:
  • Condition worsens despite appropriate therapy
  • Infection spreads beyond initial area
  • Systemic symptoms develop
  • Significant pain or bleeding occurs 1

The management of intertrigo requires both treating the current infection and addressing the underlying predisposing factors to prevent recurrence. While topical antifungals are effective for most cases, oral therapy may be necessary for extensive or resistant infections.