From the Guidelines
Intertrigo management should prioritize keeping the affected skin folds clean, dry, and separated, with the use of topical calcineurin inhibitors such as pimecrolimus or tacrolimus for intertriginous psoriasis, as supported by recent evidence 1. The management of intertrigo involves several key steps, including:
- Keeping the affected skin folds clean and dry to prevent friction and maceration
- Applying moisture-absorbing powders like zinc oxide or cornstarch to reduce moisture
- Using barrier creams containing zinc oxide or petrolatum for symptomatic relief
- Applying low-potency topical corticosteroids like hydrocortisone 1% cream for up to 7 days if inflammation is present
- Using antifungal creams such as clotrimazole 1% or miconazole 2% for 2-4 weeks for fungal intertrigo
- Using topical antibiotics like mupirocin 2% ointment for 7-10 days for bacterial infections Prevention strategies are also crucial and include:
- Wearing loose-fitting, breathable clothing
- Using absorbent materials between skin folds
- Maintaining a healthy weight
- Controlling blood glucose in diabetic patients These measures address the underlying causes of intertrigo, including moisture, friction, and secondary infections in occluded skin folds, as highlighted in studies on candidal skin infections and paronychia 1. However, the most recent and highest quality study 1 supports the use of topical calcineurin inhibitors for intertriginous psoriasis, making it the preferred treatment option.
From the Research
Intertrigo Management
Intertrigo is a superficial inflammatory dermatitis that occurs on two closely opposed skin surfaces as a result of moisture, friction, and lack of ventilation 2. The management of intertrigo involves several strategies, including:
- Identifying and educating patients on reducing predisposing factors 3
- Educating patients on skin fold management and adopting a structured skin care routine 3
- Treating secondary infections with appropriate topical agents 2, 3
- Using moisture-wicking textiles within skin folds to reduce skin-on-skin friction and wick away moisture 3
Treatment of Secondary Infections
Secondary infections, such as candidal intertrigo, can be treated with topical antifungal agents, including:
- Nystatin 2, 4
- Clotrimazole 2, 4
- Ketoconazole 2, 4
- Oxiconazole 2
- Econazole 2 Bacterial superinfections can be treated with topical mupirocin or oral penicillin 2.
Prevention
Preventing intertrigo involves reducing moisture and friction in skin folds, and improving air circulation 3, 5. This can be achieved through:
- Keeping skin folds clean and dry
- Using moisture-wicking textiles
- Avoiding tight clothing
- Losing weight if obese 5
Evidence Base
The evidence base for intertrigo management is limited, with few well-designed studies available 3, 6. Further research is needed to develop effective prevention and treatment strategies for intertrigo 3, 6.