From the Guidelines
Candidal intertrigo should be treated with topical azole antifungals, such as clotrimazole, miconazole, or nystatin, and measures to keep the affected skin folds dry, as recommended by the most recent guidelines 1. The treatment of candidal intertrigo involves a combination of topical antifungal medications and measures to keep the affected skin folds dry.
- First-line treatment includes topical azole antifungals such as clotrimazole, miconazole, and nystatin, which are effective in treating nonhematogenous primary skin infections, especially in obese and diabetic patients 1.
- Keeping the infected area dry is also crucial, as moisture can exacerbate the infection.
- Additional measures to keep the area dry include wearing loose-fitting, breathable cotton clothing, and applying absorbent powders like zinc oxide or nystatin powder.
- For recurrent or severe infections, oral antifungals like fluconazole may be necessary, but this should be determined on a case-by-case basis, considering the severity of the infection and the patient's overall health. The most recent guidelines from 2004 1 provide the best evidence for the treatment of candidal intertrigo, and should be followed in clinical practice.
From the FDA Drug Label
Adults and Pediatric Patients (Neonates and Older): Apply to candidal lesions two or three times daily until healing is complete. Sufficient Econazole Nitrate Cream, 1% should be applied to cover affected areas ... twice daily (morning and evening) in patients with cutaneous candidiasis The treatment for candidal infections includes applying nystatin (TOP) two or three times daily until healing is complete 2, or applying econazole (TOP) twice daily (morning and evening) for two weeks 3.
- Nystatin (TOP) is applied to candidal lesions
- Econazole (TOP) is applied to affected areas in patients with cutaneous candidiasis
From the Research
Treatment Options for Candidal Intertrigo
- The treatment of candidal intertrigo usually requires topical administration of nystatin and azole group antifungals 4.
- In some cases, magistral remedies can be used safely and effectively 4.
- For recalcitrant cases, the Dr Michaels® (Fungatinex®) product family has been shown to be efficacious in the treatment of candidal intertrigo, with a combination of moisturising bar, topical ointment, and oral herbal formulation 5.
- Topical therapies such as clotrimazole, nystatin, and miconazole have demonstrated similar efficacy with complete cure rates of 73%-100% 6.
- Systemic therapy with oral fluconazole has also been shown to be effective in the treatment of cutaneous candidiasis, including candidal intertrigo 6, 7.
Management of Predisposing Factors
- Identification and correction of predisposing factors, such as obesity, diabetes mellitus, and immunosuppressive conditions, is a key step in the management of candidal intertrigo 4.
- Patients should be encouraged to lose weight and receive proper follow-up after endocrinologic treatment 4.
- Intestinal colonization or periorificial infections should be medically managed, especially in recurrent and resistant cases 4.
Efficacy of Antifungal Drugs
- Fluconazole has been shown to be significantly effective in increasing mycological cure rates compared to placebo, clotrimazole, and nystatin 7.
- Ketoconazole and miconazole have also been shown to be effective in increasing mycological cure rates compared to nystatin 7.
- Nystatin has been found to be the least effective antifungal drug in increasing mycological cure rates in HIV-positive patients 7.