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
Moisture and Friction Control (Essential First Step)
- Thoroughly dry intertriginous areas after bathing using separate clean towels for the groin and other body parts to prevent cross-contamination 1
- Apply moisture-wicking textiles within skin folds to reduce skin-on-skin friction, wick away moisture, and reduce secondary infection 1, 2
- Use absorptive powders such as cornstarch or barrier creams to minimize moisture and friction 3
- Patients should wear light, nonconstricting, absorbent clothing and avoid wool and synthetic fibers 3
Topical Antifungal Therapy (First-Line Pharmacologic Treatment)
- Topical antifungals are the primary treatment: nystatin, clotrimazole, ketoconazole, oxiconazole, or econazole 4
- These agents address the common secondary candidal infection that frequently complicates intertrigo 4
Managing Secondary Infections
Candidal Intertrigo (Most Common)
- Diagnosed clinically by the characteristic appearance of satellite lesions 4
- Confirm diagnosis with potassium hydroxide preparation if needed 4
- For resistant cases, use oral fluconazole 4
- In recurrent or resistant cases with predisposing immunosuppressive conditions, novel systemic agents with higher potency may be required 5
Bacterial Superinfections
- Identify bacterial infections using bacterial culture or Wood lamp examination 4
- For streptococcal infections: topical mupirocin or oral penicillin 4
- For Corynebacterium minutissimum infections: oral erythromycin 4
Prevention and Long-Term Management
Address Predisposing Factors
- Identify and correct underlying conditions: obesity, diabetes mellitus, immunosuppressive conditions 5, 2
- Encourage weight loss in obese patients 5
- Ensure proper endocrinologic treatment and follow-up 5
- Manage intestinal colonization or periorificial infections, especially in recurrent cases 5
Lifestyle Modifications
- Physical exercise is desirable, but patients should shower afterward and thoroughly dry intertriginous areas 3
- Educate patients about precautions regarding heat, humidity, and outdoor activities 3
- For toe web intertrigo, wearing open-toed shoes can be beneficial 3
Common Pitfalls to Avoid
- Do not neglect moisture control: Pharmacologic treatment alone without addressing moisture and friction will lead to treatment failure 1, 3
- Do not use the same towel for different body areas: This promotes cross-contamination and reinfection 1
- Do not overlook secondary bacterial infections: These require specific antimicrobial therapy beyond antifungals 4
- Do not ignore recurrent cases: These warrant investigation for underlying predisposing factors like diabetes or immunosuppression 5
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