What is the most effective way to treat intertrigo?

Treatment of Intertrigo

The most effective treatment for intertrigo is keeping the affected area clean and dry combined with topical antifungal agents (clotrimazole, miconazole, or nystatin) as first-line therapy for candidal infection, which is the most common secondary complication. 1, 2

Primary Management Strategy

Moisture control is the cornerstone of successful treatment and must be addressed before any pharmacological intervention will be effective. 1, 2

• Keep affected skin folds clean and thoroughly dry 1, 3
• Patients should wear light, nonconstricting, absorbent clothing and avoid wool and synthetic fibers 3
• Shower after physical activity and meticulously dry intertriginous areas 3
• Consider moisture-wicking textiles within skin folds to reduce friction and moisture 4
• For toe web intertrigo, wearing open-toed shoes can be beneficial 3

Pharmacological Treatment Algorithm

Step 1: First-Line Topical Therapy

For candidal intertrigo (most common):

• Apply topical azoles: clotrimazole cream or miconazole cream 1, 2, 5
• Alternative: nystatin cream or powder 1, 2
• These agents should be applied to clean, dry skin 1

For suspected bacterial infection:

• Use mupirocin ointment or clindamycin lotion 1, 2
• For bullous or nonbullous impetigo: topical mupirocin or retapamulin twice daily for 5 days 1
• For suspected MRSA: consider doxycycline or trimethoprim-sulfamethoxazole 1, 2

Step 2: Escalation for Extensive or Resistant Cases

Oral antifungal therapy should be considered when topical treatment fails or disease is extensive: 1, 2

• Fluconazole 100-200 mg daily for 7-14 days 1, 2
• Itraconazole solution 200 mg daily 1, 2

Step 3: Maintenance for Recurrent Cases

For patients with recurrent intertrigo, implement maintenance therapy with intermittent application of topical antifungals. 1, 2

Special Populations Requiring Aggressive Management

Patients with obesity, diabetes mellitus, or immunocompromised status require more intensive treatment and closer monitoring, as these conditions facilitate both occurrence and persistence of intertrigo. 1, 2, 6

• Address underlying predisposing factors: encourage weight loss, optimize glycemic control, manage immunosuppression 6
• Investigate and treat intestinal colonization or periorificial infections in recurrent cases 6
• These patients are at higher risk for treatment failure and complications 1, 2

Common Pitfalls to Avoid

• Do not use irritant antiseptics, as they may aggravate intertrigo and provoke allergic contact dermatitis 7
• Avoid abrupt cessation of treatment before complete resolution, as this increases recurrence risk 6
• Do not overlook secondary infections—both bacterial and fungal can coexist and require simultaneous treatment 3, 4
• Failure to address predisposing factors (obesity, diabetes, moisture) will result in treatment failure regardless of medication choice 6

Considerations for Inverse Psoriasis

When intertrigo occurs in patients with psoriasis, low-potency topical corticosteroids or calcineurin inhibitors (tacrolimus 0.1% or pimecrolimus) may be used as steroid-sparing agents for intertriginous areas. 8

• High-potency corticosteroids should be avoided in skin folds due to increased risk of atrophy and systemic absorption 8
• Tacrolimus 0.1% ointment can be considered for inverse psoriasis, with 65% of patients achieving clear or almost clear skin after 8 weeks 8
• Calcineurin inhibitors are particularly useful for prolonged use (≥4 weeks) in thin-skinned intertriginous areas 8