What is the treatment for Intertrigo?

Treatment of Intertrigo

The first-line treatment for intertrigo is keeping the affected area dry, combined with topical antifungal agents such as clotrimazole, miconazole, or nystatin cream/powder. 1

Primary Management Strategies

• The most important intervention is keeping the affected skin folds dry to minimize moisture and friction that contribute to intertrigo 1, 2
• Use absorptive powders such as cornstarch or barrier creams to reduce skin-on-skin friction in the affected areas 2
• Topical antifungal agents are effective first-line treatments when Candida is involved, including:
  • Azoles: clotrimazole cream, miconazole cream 1
  • Polyenes: nystatin cream or powder 1
• Moisture-wicking textiles can be placed within skin folds to reduce friction, wick away moisture, and reduce secondary infection 3

Management of Secondary Infections

• For suspected bacterial infection, use topical antibacterial agents:
  • Mupirocin ointment or clindamycin lotion for localized bacterial infections 1
  • Consider doxycycline, trimethoprim-sulfamethoxazole for MRSA involvement 1
• For extensive or resistant candidal intertrigo, consider oral antifungal therapy:
  • Fluconazole 100-200 mg daily for 7-14 days 1
  • Itraconazole solution 200 mg daily 1

Lifestyle and Preventive Measures

• Patients should wear light, non-constricting, and absorbent clothing 2
• Avoid wool and synthetic fibers that can trap moisture 2
• After physical exercise, shower and thoroughly dry intertriginous areas 2
• Open-toed shoes can benefit those with toe web intertrigo 2
• Educate patients about precautions regarding heat and humidity 2

Special Considerations

• Obesity and diabetes mellitus require more aggressive management as they contribute to development and persistence of intertrigo 1, 4
• Immunocompromised patients need more intensive treatment due to increased risk of complications and treatment failure 1
• For recurrent or persistent intertrigo, consider maintenance therapy with intermittent application of topical antifungals 1
• Identify and correct predisposing factors (weight loss, proper endocrinologic treatment) to prevent recurrence, especially in resistant cases 4

Common Pitfalls to Avoid

• Avoid irritant antiseptics which may aggravate intertrigo and potentially provoke allergic contact dermatitis 5
• Don't neglect to investigate underlying conditions (diabetes, immunosuppression) that may contribute to persistent intertrigo 4
• Failure to address intestinal colonization or periorificial infections can lead to treatment resistance 4
• Inadequate drying of affected areas after bathing is a common reason for treatment failure 2, 5

The treatment approach should follow a stepwise algorithm: first ensure the area is kept dry, then apply appropriate topical agents based on whether fungal or bacterial infection is present, and escalate to oral therapy only for extensive or resistant cases 1, 3.