What is the recommended treatment for intertrigo?

Treatment of Intertrigo

The recommended first-line treatment for intertrigo is topical antifungal therapy with clotrimazole 1% cream or miconazole 2% cream applied twice daily for 7-14 days, combined with measures to reduce moisture and friction in the affected skin folds. 1

Diagnosis and Assessment

• Intertrigo presents as erythematous, macerated skin in opposing skin surfaces with peripheral scaling
• Look for satellite pustules or papules, which suggest candidal infection
• Consider potassium hydroxide (KOH) preparation to confirm fungal elements in unclear cases
• Assess for secondary bacterial infection: increased erythema, purulence, odor, or pain

Treatment Algorithm

Step 1: Address Underlying Causes and Implement Preventive Measures

• Reduce moisture and friction in affected areas:
  • Apply absorptive powders such as cornstarch (avoid talc) 2
  • Use barrier creams with zinc oxide after treatment 1
  • Wear light, non-constricting, absorbent cotton clothing 2
  • Thoroughly dry skin folds after bathing 1

Step 2: Treat Based on Clinical Presentation

For Uncomplicated Intertrigo (No Clear Secondary Infection)

• Apply barrier protection and implement preventive measures
• Consider low-potency topical corticosteroids briefly for inflammation

For Candidal Intertrigo (Most Common)

• Apply topical antifungal:
  • First-line: Clotrimazole 1% cream or miconazole 2% cream twice daily for 7-14 days 1
  • Alternatives: Ketoconazole 2% cream, oxiconazole, or econazole 3
• For resistant cases: Oral fluconazole 3

For Bacterial Superinfection

• If streptococcal: Topical mupirocin or oral penicillin 3
• If Corynebacterium: Oral erythromycin 3
• For suspected MRSA: Consider doxycycline, clindamycin, or sulfamethoxazole-trimethoprim 4

Special Considerations

For Severe or Recurrent Cases

• Evaluate for underlying conditions:
  • Diabetes mellitus
  • Obesity
  • Immunosuppression
• For resistant candidal infections:
  • Oral fluconazole 150 mg every 72 hours for 2-3 doses 1
  • For fluconazole-refractory disease: itraconazole 200 mg daily 1

For Specific Populations

• HIV-infected patients may require longer courses of treatment 1
• Patients with diabetes should have strict glycemic control
• Obese patients should be encouraged to lose weight 5

Monitoring and Follow-up

• Evaluate response within 7 days of starting treatment
• If no improvement or worsening occurs despite appropriate therapy:
  • Consider alternative antifungal agents
  • Switch from topical to oral therapy for extensive or resistant infections
  • Reassess for secondary infections or alternative diagnoses

Common Pitfalls to Avoid

• Failing to address underlying predisposing factors
• Premature discontinuation of treatment
• Inadequate application of topical agents
• Insufficient drying of affected areas
• Misdiagnosis of the causative organism
• Not considering mixed infections (fungal and bacterial)

By following this treatment approach, most cases of intertrigo can be effectively managed with resolution of symptoms and prevention of recurrence.