What are the treatment options and preventive measures for intertrigo?

Treatment and Prevention of Intertrigo

Intertrigo should be treated with topical antifungal agents as first-line therapy, along with measures to keep the affected area clean and dry to prevent recurrence. 1, 2

Understanding Intertrigo

Intertrigo is a superficial inflammatory dermatitis that occurs on two closely opposed skin surfaces due to moisture, friction, and lack of ventilation. It commonly affects:

• Skin folds in obese and diabetic patients 1
• Areas where skin surfaces rub together 2
• Natural body folds and obesity-created folds 3

Physical examination typically reveals:

• Erythematous areas with peripheral scaling 2
• Possible satellite lesions (suggestive of Candida infection) 2
• Skin breakdown from excessive friction and inflammation 2

Treatment Options

For Candidal Intertrigo

• First-line treatment: Topical antifungal agents 1, 4

  • Nystatin
  • Clotrimazole
  • Miconazole
  • Ketoconazole
  • Oxiconazole
  • Econazole

• For resistant cases: Oral fluconazole therapy 2, 5

• For severe or recurrent cases: Consider novel systemic antifungals with higher potency 5

For Secondary Bacterial Infections

• Streptococcal infections: Topical mupirocin or oral penicillin 2
• Corynebacterium infections: Oral erythromycin 2

General Management Principles

• Keep the affected area dry: Apply absorptive powders such as cornstarch 3
• Reduce friction: Apply barrier creams to affected areas 3
• Treat secondary infections: Use appropriate antiseptics, antibiotics, or antifungals depending on the pathogen 3
• For paronychia: Drainage is the most important intervention 1

Preventive Measures

• Clothing recommendations: 3

  • Wear light, non-constricting, and absorbent clothing
  • Avoid wool and synthetic fibers
  • Consider open-toed shoes for toe web intertrigo

• Hygiene practices: 3, 6

  • Shower after physical exercise
  • Thoroughly dry intertriginous areas after bathing
  • Use separate clean towels for drying the groin and other body parts
  • Complete drying of skin folds after bathing

• Environmental considerations: 3

  • Take precautions regarding heat and humidity
  • Modify activities that may exacerbate the condition

• Advanced interventions: 6

  • Consider moisture-wicking textiles within skin folds to:
    • Reduce skin-on-skin friction
    • Wick away moisture
    • Reduce secondary infection

Special Considerations for Recurrent Cases

• Identify and address predisposing factors: 5

  • Encourage weight loss in obese patients
  • Ensure proper follow-up after endocrinologic treatment for diabetic patients
  • Manage intestinal colonization or periorificial infections

• Consider magistral remedies: These can be used safely and effectively in recurrent cases 5

• Investigate potential sources of reinfection: Look for other superficial sites of infection that may serve as reservoirs 4

By following these treatment and prevention strategies, most cases of intertrigo can be effectively managed, reducing discomfort and preventing recurrence.