Treatment of Intertrigo
For uncomplicated intertrigo, topical antifungal agents (nystatin, clotrimazole, ketoconazole, oxiconazole, or econazole) combined with moisture control measures form the foundation of treatment, with oral fluconazole reserved for resistant candidal cases. 1
Initial Assessment and Diagnosis
Intertrigo presents as erythema with peripheral scaling in opposing skin folds, often with satellite lesions when Candida is involved 2. The diagnosis is primarily clinical, though confirmation can be obtained through:
- Potassium hydroxide (KOH) preparation for candidal infection 2
- Wood lamp examination to identify bacterial superinfections 2
- Bacterial culture when secondary infection is suspected 2
First-Line Management
Non-Pharmacologic Interventions (Essential First Step)
Identify and correct predisposing factors immediately, as this is the key to preventing recurrence 3, 4:
- Weight reduction in obese patients 3
- Optimize glycemic control in diabetic patients 3
- Address immunosuppressive conditions 3
- Keep affected areas dry using absorptive powders (cornstarch) or barrier creams 5
- Recommend light, nonconstricting, absorbent clothing; avoid wool and synthetic fibers 5
- Encourage showering after physical activity with thorough drying of intertriginous areas 5
- Consider moisture-wicking textiles within skin folds 4
Topical Antifungal Therapy
For candidal intertrigo (most common), apply topical agents directly to affected areas 1, 6:
These agents work by direct contact with the fungus and require simultaneous presence of antifungal and organism for adequate duration 6.
Treatment of Secondary Bacterial Infections
Streptococcal Superinfection
Topical mupirocin OR oral penicillin 2
Corynebacterium minutissimum (Erythrasma)
Oral erythromycin 2
Resistant or Recurrent Cases
For treatment-resistant candidal intertrigo, escalate to oral fluconazole 1, 2. The specific dosing from IDSA guidelines for mucocutaneous candidiasis is:
- Fluconazole 100 mg daily for 7-14 days 1
In recurrent cases, investigate for:
- Intestinal colonization requiring treatment 3
- Periorificial infections 3
- Inadequately controlled predisposing factors 3
Important Caveats
Topical antifungals are first-choice for candidal intertrigo; systemic agents are reserved for poor compliance, highly relapsing disease, or when topical therapy fails 6. The friction and moisture in skin folds create an ideal environment for both fungal and bacterial overgrowth, so always assess for mixed infections 2, 5.
Premature discontinuation leads to relapse, so continue treatment until complete resolution of lesions and maintain preventive measures long-term 3, 4.
For patients with obesity or diabetes, address these underlying conditions aggressively, as they are the primary drivers of recurrence 3, 4. Without correction of predisposing factors, even appropriate antimicrobial therapy will result in repeated episodes 3.