What is the management for intertrigo?

Management of Intertrigo

The first-line treatment for intertrigo includes keeping the affected area clean and dry, using barrier creams, and applying appropriate topical antifungal agents such as clotrimazole 1% cream or miconazole 2% cream for 7-14 days when fungal infection is present. 1, 2

Initial Assessment and General Measures

• Identify and address predisposing factors:

  • Obesity
  • Diabetes mellitus
  • Immunosuppressive conditions
  • Excessive sweating
  • Poor hygiene 3

• Basic skin care measures:

  • Keep affected areas clean and dry
  • Use mild, soap-free cleansers for gentle washing
  • Thoroughly dry skin folds after bathing
  • Apply absorptive powders like cornstarch (avoid talc) 1, 4

• Reduce friction and moisture:

  • Wear light, non-constricting, absorbent cotton clothing
  • Avoid synthetic fabrics and tight clothing
  • Use barrier creams containing zinc oxide after cleansing
  • Consider petroleum jelly to protect fissures and surrounding skin 1, 4

Treatment Based on Causative Agent

1. Candidal Intertrigo

• First-line treatment:

  • Topical antifungals: clotrimazole 1% cream, miconazole 2% cream, or nystatin powder/cream applied 2-3 times daily for 7-14 days 1, 2
  • Look for characteristic satellite lesions to identify candidal infection 2
  • Diagnosis can be confirmed using potassium hydroxide (KOH) preparation 2

• For resistant or severe cases:

  • Oral fluconazole 200-400 mg daily for 7-14 days 1, 2
  • Consider evaluation for underlying conditions such as immunodeficiency or diabetes 1

2. Bacterial Superinfections

• For streptococcal infections:

  • Topical mupirocin or oral penicillin 2
  • Diagnosis may be confirmed with bacterial culture or Wood lamp examination 2

• For Corynebacterium infections (erythrasma):

  • Oral erythromycin 2
  • Wood lamp examination shows coral-red fluorescence

3. Inflammatory Component

• For inflammation and irritation:
  • Low-potency topical corticosteroids (hydrocortisone 1% or 2.5%) for short-term use 1
  • Tacrolimus 0.1% ointment can be considered as an alternative to steroids in intertriginous areas 1
  • Calcitriol (vitamin D analog) may be used as it is less irritating on sensitive skin areas 1

Special Considerations

• For toe web intertrigo:

  • Recommend open-toed shoes to improve ventilation 4
  • Keep spaces between toes dry

• For obese patients:

  • Encourage weight loss as a long-term solution 3, 4
  • Consider using absorbent cloths or cotton between skin folds

• For diabetic patients:

  • Ensure proper glycemic control
  • Monitor closely for secondary infections 3

Prevention Strategies

• Educate patients on proper hygiene practices
• Shower after physical exercise and thoroughly dry intertriginous areas
• Regular monitoring of high-risk patients (diabetics, obese, immunocompromised)
• Address periorificial infections and intestinal colonization in recurrent cases 3

Treatment Pitfalls to Avoid

• Avoid irritant antiseptics that may aggravate intertrigo or cause allergic contact dermatitis 5
• Do not use high-potency topical steroids in skin folds due to increased risk of skin atrophy
• Avoid prolonged antifungal use without confirming diagnosis
• Remember that intertrigo is often multifactorial, requiring attention to both the inflammatory component and potential secondary infections 6