What is the treatment for intertrigo?

Treatment of Intertrigo

The first-line treatment for intertrigo involves keeping the affected area clean and dry, applying topical antifungal agents such as clotrimazole 1% cream or miconazole 2% cream twice daily for 7-14 days, and using barrier creams to reduce friction and moisture. 1

Understanding Intertrigo

Intertrigo is an inflammatory skin condition that occurs in skin folds where skin-to-skin friction, moisture, and poor air circulation create an environment conducive to inflammation and secondary infections. Common locations include:

• Intertriginous areas (axillae, groin, inframammary regions)
• Abdominal folds
• Intergluteal and perineal areas
• Toe and finger webs

Diagnostic Considerations

• Erythematous, macerated skin in skin folds
• Satellite pustules or papules (suggestive of Candida infection)
• Burning, itching, or pain in affected areas
• Malodor (suggesting secondary bacterial infection)

Treatment Algorithm

Step 1: General Measures (For All Patients)

• Keep affected areas clean and dry
• Minimize skin-on-skin friction
• Apply absorptive powders (cornstarch) to reduce moisture 2
• Use barrier creams containing zinc oxide after cleansing 1
• Wear light, non-constricting, absorbent cotton clothing 2

Step 2: Treat Secondary Infections

For Candidal Infection (most common):

• Apply topical antifungal agents:
  • Clotrimazole 1% cream twice daily for 7-14 days 1
  • Miconazole 2% cream twice daily for 7-14 days 1
  • Nystatin can be used as an alternative when azoles are not available 1

For Bacterial Infection:

• Apply topical antiseptics or antibiotics based on suspected pathogens 2
• For streptococcal intertrigo, appropriate antibiotics should be administered 3

For Mixed Infections:

• Consider combination products containing antifungal and mild corticosteroid for short-term use in cases with significant inflammation 1

Step 3: For Persistent or Recurrent Cases

• Evaluate for predisposing factors (diabetes, obesity, immunosuppression) 4
• Consider oral antifungals for extensive candidal infections:
  • Fluconazole 150 mg every 72 hours for 2-3 doses 1
  • For fluconazole-refractory disease, itraconazole 200 mg daily 1

Special Considerations

For Diabetic Patients

• Optimize glycemic control
• More frequent monitoring for secondary infections
• May require longer treatment courses

For Obese Patients

• Encourage weight loss 4
• Consider moisture-wicking textiles within skin folds 5
• More frequent cleansing and drying of affected areas

For Immunocompromised Patients

• Lower threshold for systemic therapy
• Consider prophylactic regimens during high-risk periods 1
• More frequent monitoring for breakthrough infections

Prevention Strategies

• Maintain good hygiene with gentle cleansing using mild soap-free cleansers
• Thoroughly dry skin folds after bathing
• Apply zinc oxide-based barrier creams to protect vulnerable areas 1
• Wear appropriate clothing that reduces friction and moisture
• Shower after physical exercise and thoroughly dry intertriginous areas 2
• For toe web intertrigo, wearing open-toed shoes can be beneficial 2

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
  • Evaluate for other skin conditions that may mimic intertrigo
  • Consider oral antifungal therapy for extensive or resistant infections 1

Pitfalls to Avoid

• Inadequate drying after cleansing (promotes maceration)
• Insufficient treatment duration (complete the full 7-14 day course) 1
• Treating only visible lesions rather than all affected areas 1
• Using talc-containing powders (cornstarch is preferred) 1
• Overuse of topical corticosteroids (can worsen fungal infections)
• Failure to address underlying medical conditions

By following this structured approach to the management of intertrigo, most cases can be effectively treated and recurrences minimized.