Treatment of Erythema Intertrigo
For erythema intertrigo, the recommended treatment includes keeping the affected area clean and dry, using topical antifungals for Candida infections, applying mild corticosteroids for inflammation, and addressing underlying causes to prevent recurrence.
General Management Principles
Hygiene and Moisture Control
- Keep affected skin folds clean and dry to minimize friction and moisture 1
- Use mild soaps or soap-free cleansing bases with lukewarm water 2
- Thoroughly dry the area after bathing, patting gently rather than rubbing 2
- Apply absorptive powders such as cornstarch to reduce moisture 1
Clothing and Environmental Modifications
- Wear light, non-constricting, and absorbent clothing; avoid wool and synthetic fibers 1
- Choose fine cotton clothes instead of synthetic materials 2
- For toe web intertrigo, wearing open-toed shoes can be beneficial 1
- Minimize heat and humidity exposure, and shower after physical exercise 1
Treatment Based on Severity and Complications
Mild Intertrigo (Without Secondary Infection)
- Apply barrier creams to minimize skin-on-skin friction 1
- Consider adsorbent lotions containing ingredients like tapioca starch, aloe barbadensis, and allantoin, which have shown efficacy comparable to low-potency corticosteroids 3
- Moisture-wicking textiles can be placed within skin folds to reduce friction and wick away moisture 4
Intertrigo with Secondary Fungal Infection (Candidal)
- Topical antifungals are the mainstay of treatment for candidal intertrigo 5
- Apply topical nystatin or azole antifungals to affected areas 5
- For recurrent candidal intertrigo, address potential intestinal colonization or periorificial infections 5
Intertrigo with Secondary Bacterial Infection
- Treat with appropriate topical antiseptics or antibiotics 1
- Fusidic acid can be applied to the affected area 3-4 times daily for patients 2 years and older 6
- For impetiginization (commonly caused by staphylococci or streptococci), obtain bacterial swabs and start calculated anti-infective treatment 2
Moderate to Severe Inflammatory Intertrigo
- Short-term use of mild to moderate potency topical corticosteroids (e.g., hydrocortisone 1%) can reduce inflammation 2, 3
- Topical calcineurin inhibitors like pimecrolimus may be considered, though evidence is mixed 2
- For severe inflammation with erythema and desquamation, short-term oral systemic steroids may be recommended 2
Management of Pruritus
- Apply moisturizers and urea- or polidocanol-containing lotions to soothe itching 2
- For moderate to severe pruritus, oral H1-antihistamines such as cetirizine, loratadine, or fexofenadine may provide relief 2
Prevention of Recurrence
- Identify and address predisposing factors such as obesity and diabetes mellitus 5
- Encourage weight loss in overweight patients 5
- Educate patients on proper skin fold management and structured skin care routines 4
- Regular application of barrier products in susceptible areas, even when symptoms have resolved 4
Special Considerations
- Avoid greasy creams for basic care as they might facilitate folliculitis due to occlusive properties 2
- Topical steroids should be used cautiously and for short durations to avoid skin atrophy and perioral dermatitis 2
- In immunosuppressed patients or those with diabetes, more aggressive treatment and monitoring may be needed 5