Treatment of Intertrigo
First-line treatment for intertrigo is topical antifungal agents, combined with aggressive moisture control and friction reduction measures. 1
Initial Management Approach
Identify and Address Predisposing Factors
- Moisture control is the cornerstone of treatment - thoroughly dry intertriginous areas after bathing using separate clean towels for the groin and other body parts 1
- Target modifiable risk factors including obesity, diabetes mellitus, and immunosuppressive conditions that facilitate both occurrence and recurrence 2
- Patients should wear light, nonconstricting, absorbent clothing and avoid wool and synthetic fibers 3
Topical Antifungal Therapy (First-Line)
- Topical antifungals are the recommended first-line treatment according to Clinical Infectious Diseases guidelines 1
- Specific agents include: nystatin, clotrimazole, ketoconazole, oxiconazole, or econazole 4
- These agents target Candida species, which commonly cause secondary infections in intertrigo 4
Managing Secondary Infections
Candidal Intertrigo
- Diagnosed clinically by the characteristic appearance of satellite lesions 4
- Confirm diagnosis with potassium hydroxide (KOH) preparation if needed 4
- Resistant cases require oral fluconazole therapy 4
- In immunosuppressed patients or generalized infections, systemic agents with higher potency may be necessary 2
Bacterial Superinfections
- Identify bacterial infections using bacterial culture or Wood lamp examination 4
- Streptococcal infections: treat with topical mupirocin or oral penicillin 4
- Corynebacterium minutissimum infections: treat with oral erythromycin 4
Prevention Strategies
Friction and Moisture Reduction
- Use moisture-wicking textiles within skin folds to reduce skin-on-skin friction, wick away moisture, and reduce secondary infection 1, 5
- Apply absorptive powders such as cornstarch or barrier creams to minimize moisture and friction 3
- For toe web intertrigo specifically, wearing open-toed shoes can be beneficial 3
Hygiene and Activity Modifications
- Physical exercise is desirable, but patients must shower afterward and thoroughly dry intertriginous areas 3
- Educate patients about precautions regarding heat, humidity, and outdoor activities 3
- Adopt a structured skin care routine with proper skin fold management 5
Common Pitfalls to Avoid
- Do not rely solely on topical therapy without addressing underlying moisture and friction - this leads to treatment failure and recurrence 2, 5
- Do not overlook secondary bacterial infections - intertrigo creates skin breakdown that serves as an entry point for bacterial pathogens including group A beta-hemolytic streptococcus 4
- Do not ignore systemic factors - inadequately controlled diabetes, untreated obesity, and intestinal colonization must be addressed in recurrent cases 2
- In treatment-resistant or recurrent cases, perform laboratory studies to establish differential diagnosis rather than continuing empiric therapy 2