What is the recommended treatment for intertrigo?

Treatment of Intertrigo

The most effective treatment for intertrigo involves keeping the affected area dry as the primary intervention, combined with appropriate topical antifungal agents as first-line therapy. 1

Primary Management Strategies

• The cornerstone of intertrigo management is minimizing moisture and friction in affected areas by using absorptive powders such as cornstarch or barrier creams 2
• Keeping the affected area clean and dry is the most important intervention for successful treatment 1
• Patients should wear light, non-constricting, and absorbent clothing while avoiding wool and synthetic fibers that can trap moisture 2
• Physical exercise is beneficial but should be followed by thorough showering and complete drying of intertriginous areas 2

Pharmacological Treatment

For Candidal Intertrigo

• Topical antifungal agents are the first-line treatment for candidal intertrigo: 1
  • Azoles: clotrimazole cream, miconazole cream
  • Polyenes: nystatin cream or powder
• For extensive or resistant cases of candidal intertrigo, oral antifungal therapy may be considered: 1
  • Fluconazole 100-200 mg daily for 7-14 days
  • Itraconazole solution 200 mg daily

For Bacterial Intertrigo

• When bacterial infection is suspected, topical antibacterial agents should be used: 1
  • Mupirocin ointment
  • Clindamycin lotion
• For suspected MRSA involvement, consider: 1, 3
  • Doxycycline
  • Trimethoprim-sulfamethoxazole
  • For bullous and nonbullous impetigo, topical mupirocin or retapamulin twice daily for 5 days 3

Special Considerations

• For patients with obesity, diabetes mellitus, or immunocompromised status: 1, 4
  • More aggressive management is required as these conditions contribute to development and persistence of intertrigo
  • Closer follow-up and potentially longer treatment courses may be necessary
• For recurrent cases: 4
  • Identify and address underlying predisposing factors (weight loss for obesity, glycemic control for diabetes)
  • Consider maintenance therapy with intermittent application of topical antifungals
  • Investigate and treat potential sources of reinfection, including intestinal colonization or periorificial infections

Prevention Strategies

• Educate patients about precautions regarding heat and humidity 2
• For toe web intertrigo, recommend wearing open-toed shoes 2
• Consider using moisture-wicking textiles within skin folds to reduce skin-on-skin friction and wick away moisture 5
• Establish a structured skin care routine focusing on keeping intertriginous areas clean and dry 5

Treatment Algorithm

1. Identify and address predisposing factors (obesity, diabetes, immunosuppression)
2. Implement basic hygiene measures (keeping area dry, wearing appropriate clothing)
3. Apply topical antifungal for suspected candidal infection or antibacterial for suspected bacterial infection
4. For persistent or extensive cases, consider oral antifungal therapy
5. For recurrent cases, implement maintenance therapy and investigate potential sources of reinfection

By following these guidelines and addressing both the primary condition and any secondary infections, most cases of intertrigo can be effectively managed with significant improvement in symptoms and quality of life 4.