What is the treatment for intertrigo?

Treatment of Intertrigo

The first-line treatment for intertrigo includes keeping the affected area clean and dry, applying topical antifungal agents such as clotrimazole 1% cream, miconazole 2% cream, or nystatin powder/cream 2-3 times daily for 7-14 days, and addressing underlying causes. 1

Diagnosis and Etiology

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

• Moisture
• Friction
• Lack of ventilation 2

Physical examination typically reveals:

• Erythematous areas in skin folds
• Peripheral scaling
• Possible satellite lesions (suggestive of candidal infection) 2

Treatment Algorithm

1. Primary Management

• Keep the area clean and dry

  • Gentle cleansing with mild soap-free cleansers
  • Thorough drying after bathing
  • Apply absorptive powders like cornstarch (avoid talc) 1

• Reduce friction and moisture

  • Wear light, non-constricting, absorbent cotton clothing
  • Avoid synthetic fabrics and tight clothing 1
  • Consider moisture-wicking textiles within skin folds 3

2. Antifungal Treatment

For candidal intertrigo (common secondary infection):

• First-line: Topical antifungals

  • Clotrimazole 1% cream twice daily for 7-14 days
  • Miconazole 2% cream twice daily for 7-14 days
  • Nystatin powder/cream 2-3 times daily for 7-14 days
  • Ketoconazole 2% cream 2-3 times daily for 14 days 1, 2

• For resistant cases:

  • Oral fluconazole 200-400 mg daily for 2 weeks 1, 2
  • Consider a loading dose of 800 mg for severe infections 1

3. For Bacterial Superinfections

• Streptococcal infections:

  • Topical mupirocin or oral penicillin 2

• Corynebacterium infections (erythrasma):

  • Oral erythromycin 2

4. For Severe or Mixed Infections

• Consider combination therapy with antifungal and mild corticosteroid for rapid relief of inflammation and pruritus 4
• Identify and treat all sites of infection 5

Prevention and Long-term Management

• Apply zinc oxide-based barrier creams after treatment 1
• Consider petroleum jelly to protect fissures and surrounding skin 1
• Address underlying conditions (diabetes, obesity, immunosuppression) 6
• Educate patients on proper hygiene and clothing choices 6
• For toe web intertrigo, recommend open-toed shoes 6
• Shower after physical exercise and thoroughly dry intertriginous areas 6

Common Pitfalls and Caveats

1. Failure to identify and address predisposing factors

   • Obesity, diabetes, incontinence, and immunosuppression can all contribute to persistent intertrigo 6, 3

2. Inadequate diagnosis of secondary infections

   • Consider potassium hydroxide preparation to confirm candidal infection
   • Use bacterial culture or Wood lamp examination to identify bacterial superinfections 2

3. Insufficient treatment duration

   • Continue treatment until complete resolution of symptoms 1

4. Neglecting preventive measures

   • Long-term management requires ongoing attention to keeping the area dry and reducing friction 6, 3

5. Missing other infection sites

   • Always check for other superficial sites of infection that may serve as a reservoir 5