What is the recommended treatment for intertrigo?

Treatment of Intertrigo

For intertrigo, treatment should focus on keeping the affected area dry, reducing friction, and addressing secondary infections with appropriate topical antifungal or antibacterial agents based on the causative organism. 1, 2

Primary Management Strategies

1. Non-Pharmacological Measures

• Keep affected areas clean and dry
• Minimize moisture and friction with absorptive powders such as cornstarch 3
• Use barrier creams to protect skin folds 3
• Wear light, non-constricting, absorbent clothing; avoid wool and synthetic fibers 3
• Shower after physical exercise and thoroughly dry intertriginous areas 3
• Consider moisture-wicking textiles within skin folds to reduce friction and wick away moisture 4

2. Treatment of Candidal Intertrigo

• First-line treatment: Topical antifungal agents 1, 5

  • Azoles: clotrimazole, miconazole
  • Polyenes: nystatin
  • Apply to affected areas for 7-14 days

• For resistant cases: Oral fluconazole therapy 2

3. Treatment of Bacterial Superinfections

• For streptococcal infections: Topical mupirocin or oral penicillin 2
• For Corynebacterium infections: Oral erythromycin 2
• For MRSA infections: Consider trimethoprim-sulfamethoxazole, clindamycin, or linezolid based on severity 6

Treatment Algorithm

1. Initial Assessment:

   • Identify predisposing factors (obesity, diabetes, excessive sweating)
   • Evaluate for secondary infections
   • Look for satellite lesions (suggestive of candidal infection)

2. Basic Treatment for All Cases:

   • Implement non-pharmacological measures to keep area dry and reduce friction
   • Apply barrier creams or absorptive powders

3. If Candidal Infection Suspected (satellite lesions present):

   • Apply topical antifungal (clotrimazole, miconazole, or nystatin) 2-3 times daily for 7-14 days 1, 5
   • For extensive or resistant cases, consider oral fluconazole 2

4. If Bacterial Superinfection Suspected:

   • For localized infection: Apply topical mupirocin 2% ointment three times daily for 7-10 days 6
   • For extensive infection: Consider appropriate oral antibiotics based on suspected pathogen 6, 2

5. For Mixed Infections:

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

Special Considerations

• Diabetic Patients: More aggressive treatment and closer monitoring may be needed due to increased risk of complications
• Obese Patients: Weight loss should be encouraged as a long-term strategy to prevent recurrence 4, 3
• Recurrent Cases: Consider maintenance therapy and more aggressive addressing of predisposing factors 4

Common Pitfalls to Avoid

• Failure to address underlying predisposing factors leading to recurrence 7
• Using irritant antiseptics that may aggravate intertrigo or cause allergic contact dermatitis 7
• Inadequate drying of affected areas after cleansing
• Not treating secondary infections appropriately
• Overlooking other sites of infection that may serve as reservoirs 5

Prevention

• Regular cleansing and thorough drying of skin folds
• Use of absorbent powders in susceptible areas, especially during hot, humid weather
• Weight loss for obese patients
• Control of underlying conditions such as diabetes
• Wearing appropriate clothing that reduces friction and promotes ventilation 3