How to treat intertrigo under the arm and groin?

Treatment of Intertrigo Under the Arm and Groin

For intertrigo in the axillary and groin regions, topical antifungal agents combined with keeping the affected areas dry are the most effective first-line treatments. 1

Diagnosis and Identification

• Intertrigo presents as erythema with peripheral scaling in skin folds, often exacerbated by moisture, friction, and lack of ventilation 2
• Candidal intertrigo can be identified by characteristic satellite lesions; diagnosis may be confirmed with potassium hydroxide (KOH) preparation 2
• Bacterial intertrigo may require bacterial culture or Wood lamp examination for proper identification 2

Treatment Algorithm

First-line Treatment for Candidal Intertrigo

• Apply topical antifungal agents such as:
  • Nystatin cream/powder 1, 2
  • Clotrimazole cream 1, 2
  • Ketoconazole cream 1, 2
  • Econazole cream 2
  • Oxiconazole cream 2

For Bacterial Superinfection

• If streptococcal infection is suspected:
  • Apply topical mupirocin or prescribe oral penicillin 2
• For Corynebacterium infections:
  • Prescribe oral erythromycin 2
• For Gram-negative bacterial infections (especially Pseudomonas):
  • Use appropriate antibiotics based on culture results 3

For Resistant Candidal Infections

• Prescribe oral fluconazole for resistant cases 2, 4
• Consider novel systemic antifungals for immunosuppressed patients 4

For Inflammatory Component

• Apply topical corticosteroids for associated inflammation or eczema 5
• Use low to moderate potency steroids for short periods to reduce inflammation 5

Essential Preventive Measures

• Keep the affected areas dry 1, 6:
  • Use absorptive powders such as cornstarch 6
  • Apply barrier creams to minimize friction 6
• Recommend wearing light, non-constricting, and absorbent clothing 6
• Advise patients to avoid wool and synthetic fibers 6
• Educate about precautions regarding heat and humidity 6
• Recommend showering after physical exercise and thoroughly drying intertriginous areas 6

Management of Predisposing Factors

• Address underlying conditions that contribute to recurrence 4:
  • Encourage weight loss in obese patients 4
  • Ensure proper management of diabetes mellitus 4
  • Treat any immunosuppressive conditions 4
  • Manage intestinal colonization or periorificial infections 4

Common Pitfalls to Avoid

• Failure to identify the correct pathogen can lead to ineffective treatment 3
• Overuse of topical steroids without addressing the underlying infection can worsen the condition 5
• Not addressing moisture and friction will lead to treatment failure 6
• Neglecting patient education about proper hygiene can result in recurrent infections 3
• Misdiagnosis of bacterial intertrigo as fungal infection or eczema can lead to inappropriate treatment 3

Special Considerations

• For toe web intertrigo, wearing open-toed shoes can be beneficial 6
• For recurrent cases, consider magistral remedies (compounded medications) that combine antifungals with mild anti-inflammatory agents 4
• Persistent or recurrent cases may require evaluation for underlying systemic conditions 4