What is the treatment for intertrigo?

Treatment of Intertrigo

The treatment of intertrigo should focus on keeping the affected area clean and dry, applying topical antifungals for candidal infections, using low-potency corticosteroids for inflammation, and addressing any secondary bacterial infections with appropriate antibiotics. 1, 2

Initial Management

Non-pharmacological Measures

• Keep the area clean and dry:

  • Use gentle cleansing with mild soap-free cleansers
  • Thoroughly dry after bathing 1
  • Apply absorptive powders like cornstarch (avoid talc) 2
  • Use barrier creams containing zinc oxide 1

• Reduce friction and moisture:

  • Wear light, non-constricting, absorbent cotton clothing
  • Avoid synthetic fabrics and tight clothing 2
  • Consider moisture-wicking textiles within skin folds 3
  • For toe web intertrigo, wearing open-toed shoes can be beneficial 2

Pharmacological Treatment

For Candidal Intertrigo (most common):

1. First-line topical treatment:

   • Clotrimazole 1% cream or miconazole 2% cream applied twice daily for 7-14 days 1
   • Alternative topical azoles: ketoconazole cream 2%, applied 2-3 times daily for 14 days 1

2. For resistant or extensive candidal infections:

   • Oral fluconazole 100-200 mg daily for 7-14 days 1
   • For fluconazole-resistant species, consider alternative antifungals 1

For Inflammatory Component:

• Low-potency topical corticosteroids (use cautiously in intertriginous areas):
  • For intertriginous areas: hydrocortisone 1% or 2.5% for short-term use 4
  • Tacrolimus 0.1% ointment can be considered as a first-line therapy for intertriginous inflammation 4

For Secondary Bacterial Infections:

• For streptococcal infection: Oral penicillin or first-generation cephalosporins 1
• For staphylococcal infection: Dicloxacillin or cephalexin 1
• For suspected MRSA: Doxycycline, clindamycin, or SMX-TMP 1

Special Considerations

For Inverse Psoriasis (Psoriatic Intertrigo)

• Topical tacrolimus may be considered a first line of therapy 4
• Lower potencies of topical corticosteroids to minimize risks of irritation and atrophy 4
• Consider calcitriol (vitamin D analog) which is less irritating and better tolerated on sensitive skin areas 4

For Recurrent Cases

1. Identify and address predisposing factors:

   • Weight loss for obese patients 5
   • Glycemic control for diabetic patients 5
   • Management of immunosuppressive conditions 5

2. Consider maintenance therapy:

   • Weekly application of antifungal creams may prevent recurrence 5
   • Regular use of barrier creams or powders 2

Monitoring and Follow-up

• Monitor for spread of infection to other areas
• Assess for improvement within 1-2 weeks of treatment
• If no improvement or worsening occurs, consider:
  • Obtaining cultures to identify specific pathogens
  • Changing antimicrobial therapy based on culture results
  • Evaluating for underlying systemic conditions 1, 5

Common Pitfalls to Avoid

• Using high-potency corticosteroids in intertriginous areas (increases risk of atrophy) 4
• Prolonged use of topical corticosteroids without addressing underlying causes 4
• Failing to identify and manage predisposing factors (obesity, diabetes, immunosuppression) 5
• Using irritant antiseptics that may aggravate intertrigo or provoke allergic contact dermatitis 6
• Inadequate drying of affected areas after cleansing 2

Intertrigo is a common condition that requires attention to both the inflammatory process and any secondary infections. Proper skin care, appropriate topical treatments, and addressing underlying predisposing factors are essential for effective management and prevention of recurrence.