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 reducing moisture and friction in affected skin folds through proper hygiene and keeping the area dry 1, 2
- Use absorptive powders such as cornstarch or barrier creams to minimize moisture and friction in the affected areas 2
- Patients should wear light, non-constricting, and absorbent clothing while avoiding wool and synthetic fibers that can trap moisture 2
- Encourage proper ventilation of skin folds and thorough drying after bathing or swimming 3, 4
Pharmacological Treatment for Candidal Intertrigo
- Topical antifungal agents are first-line treatment for candidal intertrigo 1, 5:
- Azoles: clotrimazole cream, miconazole cream, ketoconazole cream, oxiconazole, or econazole
- Polyenes: nystatin cream or powder
- For extensive or resistant cases of candidal intertrigo, oral antifungal therapy may be necessary 1, 6:
- Fluconazole 100-200 mg daily for 7-14 days
- Itraconazole solution 200 mg daily
Management of Secondary Bacterial Infections
- For suspected bacterial superinfection, use topical antibacterial agents 1, 3:
- Mupirocin ointment for streptococcal infections
- Clindamycin lotion for general bacterial infections
- For streptococcal infections, consider oral penicillin if topical treatment is insufficient 3
- For Corynebacterium infections (erythrasma), treat with oral erythromycin 3
- Consider doxycycline or trimethoprim-sulfamethoxazole if MRSA involvement is suspected 1
Special Considerations
- Identify and address predisposing factors such as obesity, diabetes mellitus, and immunosuppression 1, 6
- For patients with diabetes, strict glycemic control is essential to prevent recurrence 6
- For obese patients, weight loss should be encouraged as it significantly reduces recurrence 6, 4
- For recurrent or persistent intertrigo, consider maintenance therapy with intermittent application of topical antifungals 1
- Educate patients about precautions regarding heat, humidity, and physical activities 2
- After exercise, patients should shower and thoroughly dry intertriginous areas 2
Prevention Strategies
- Implement a structured skin care routine focusing on keeping skin folds clean and dry 4
- Consider using moisture-wicking textiles within skin folds to reduce skin-on-skin friction 4
- For toe web intertrigo, wearing open-toed shoes can be beneficial 2
- Investigate and eradicate potential sources of reinfection in recurrent cases 5
By addressing both the underlying causes and secondary infections, intertrigo can be effectively managed to improve patient comfort and prevent recurrence.