What is the treatment for intertrigo?

Treatment of Intertrigo

The first-line treatment for intertrigo involves keeping the affected area clean and dry, using barrier creams, and treating secondary infections with appropriate topical antifungals or antibiotics based on the causative organism. 1, 2

Understanding Intertrigo

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

• Moisture
• Friction
• Lack of ventilation

Common locations include:

• Axillae
• Inframammary folds
• Abdominal folds
• Groin
• Intergluteal areas
• Toe webs

Primary Management Approach

Non-pharmacological Interventions

• Keep affected areas clean and dry
• Use gentle cleansing with mild soap-free cleansers
• Thoroughly dry after bathing
• Apply absorptive powders like cornstarch (avoid talc) 1
• Apply zinc oxide-based barrier creams 3
• Consider petroleum jelly to protect fissures and surrounding skin

Clothing and Lifestyle Modifications

• Wear light, non-constricting, absorbent cotton clothing
• Avoid synthetic fabrics and tight clothing
• Shower after physical exercise and thoroughly dry intertriginous areas
• Wear open-toed shoes for toe web intertrigo 1

Treatment of Secondary Infections

Candidal Intertrigo

Candida is a common secondary infection in intertrigo, presenting with satellite pustules.

First-line treatment:

• Topical azole antifungals: clotrimazole 1% cream or miconazole 2% cream applied twice daily for 7-14 days 3, 2
• Alternative topical options: ketoconazole cream 2%, oxiconazole, or econazole applied 2-3 times daily for 14 days 3
• For resistant cases: oral fluconazole 100-200 mg/day for 7-14 days 3, 2

Bacterial Superinfections

For streptococcal infections:

• Topical mupirocin or oral penicillin 2

For Corynebacterium infections:

• Oral erythromycin 2

Management of Recurrent or Resistant Cases

For recurrent or resistant intertrigo, consider:

1. Identifying and addressing underlying predisposing factors:

   • Weight loss for obesity
   • Glycemic control for diabetes
   • Treatment of immunosuppressive conditions 4

2. For resistant candidal intertrigo:

   • Oral fluconazole 200-400 mg/day for 14-21 days 3, 2
   • Consider evaluation for intestinal colonization or periorificial infections 4

3. For severe cases with extensive involvement:

   • Consider systemic antifungals with higher potency 4

Special Considerations

Diagnosis Confirmation

• Candidal intertrigo is commonly diagnosed clinically based on characteristic appearance of satellite lesions
• Potassium hydroxide (KOH) preparation can confirm fungal elements
• Bacterial culture or Wood lamp examination may identify bacterial superinfections 2

Monitoring

• Follow-up to ensure resolution of infection
• Monitor for recurrence
• For patients on systemic therapy, monitor liver function tests every 1-2 weeks 3

Common Pitfalls to Avoid

1. Failing to identify and address underlying predisposing factors
2. Inadequate drying of affected areas
3. Using talc-based powders (use cornstarch instead)
4. Not treating secondary infections appropriately
5. Discontinuing treatment prematurely before complete resolution
6. Neglecting patient education on prevention strategies

By following this comprehensive approach to intertrigo management, focusing on keeping the area dry, reducing friction, and appropriately treating secondary infections, most cases can be effectively managed with significant improvement in patient comfort and quality of life.