Treatment of Intertrigo
First-line treatment for intertrigo is topical antifungal agents. 1
General Management Approach
Initial Treatment Steps
- Minimize moisture and friction using absorptive powders (such as cornstarch) or barrier creams 2
- Thoroughly dry intertriginous areas after bathing using separate clean towels for the groin and other body parts 1
- Identify and correct predisposing factors including obesity, diabetes mellitus, and immunosuppressive conditions 3
Topical Antifungal Therapy (Primary Treatment)
For candidal intertrigo (the most common secondary infection):
- Topical nystatin, clotrimazole, ketoconazole, oxiconazole, or econazole 4
- These agents are effective for fungal lesions that commonly complicate intertrigo 4
- Diagnosis can be confirmed with potassium hydroxide preparation if satellite lesions are present 4
Treatment of Secondary Bacterial Infections
If bacterial superinfection is identified:
- Streptococcal infections: Topical mupirocin or oral penicillin 4
- Corynebacterium infections: Oral erythromycin 4
- Bacterial culture or Wood lamp examination can help identify the pathogen 4
Resistant or Recurrent Cases
- Oral fluconazole for resistant candidal intertrigo 4
- Consider systemic antifungals with higher potency if predisposing immunosuppressive conditions or generalized infections are present 3
Prevention Strategies
Clothing and Lifestyle Modifications
- Wear light, nonconstricting, and absorbent clothing; avoid wool and synthetic fibers 2
- Use moisture-wicking textiles within skin folds to reduce skin-on-skin friction, wick away moisture, and reduce secondary infection 1, 5
- Wear open-toed shoes for toe web intertrigo 2
Hygiene Practices
- Shower after physical exercise and dry intertriginous areas thoroughly 2
- Adopt a structured skin care routine focused on skin fold management 5
- Educate patients about precautions regarding heat, humidity, and outside activities 2
Long-term Management
- Weight loss should be encouraged in obese patients 3
- Proper endocrinologic follow-up for diabetic patients 3
- Manage intestinal colonization or periorificial infections medically, especially in recurrent and resistant cases 3
Common Pitfalls
- Avoid irritant antiseptics as they may aggravate intertrigo and provoke allergic contact dermatitis 6
- Do not overlook secondary infections—physical examination should look for satellite lesions (candida), erythema with peripheral scaling, and signs of bacterial involvement 4
- Recurrent cases require investigation for underlying predisposing factors rather than just repeated topical treatment 3