Treatment of Intertrigo
The first-line treatment for intertrigo is keeping the affected area clean and dry, combined with topical antifungal agents (clotrimazole, miconazole, or nystatin) for candidal infections or topical antibacterials (mupirocin or clindamycin) for bacterial infections. 1, 2
Primary Management Strategy
Moisture control is the cornerstone of successful treatment. The most critical intervention is maintaining dryness in affected skin folds, as moisture and friction create the pathologic environment 1, 2. This takes priority over all pharmacologic interventions.
Basic Hygiene Measures
- Thoroughly dry intertriginous areas after bathing using separate clean towels for the groin versus other body parts 2
- Use moisture-wicking textiles within skin folds to reduce skin-on-skin friction and wick away moisture 2, 3
- Wear light, nonconstricting, absorbent clothing while avoiding wool and synthetic fibers 4
- Consider open-toed shoes for toe web intertrigo 4
- Apply absorptive powders such as cornstarch or barrier creams to minimize moisture and friction 4
Pharmacologic Treatment Algorithm
Step 1: Topical Therapy Based on Suspected Pathogen
For Candidal Intertrigo (most common):
- First-line: Topical azoles (clotrimazole cream or miconazole cream) or polyenes (nystatin cream or powder) 1
- These are the preferred initial agents based on guideline recommendations 1
For Bacterial Intertrigo:
- Mupirocin ointment or clindamycin lotion for suspected bacterial infection 1
- For suspected MRSA: doxycycline or trimethoprim-sulfamethoxazole 1
- For bullous and nonbullous impetigo: topical mupirocin or retapamulin twice daily for 5 days 1
Step 2: Escalation for Extensive or Resistant Cases
For persistent candidal intertrigo despite topical therapy:
Step 3: Maintenance for Recurrent Cases
- Intermittent application of topical antifungals for recurrent cases 1
- Investigate and address potential sources of reinfection 1
Special Populations Requiring Aggressive Management
High-risk patients need more intensive treatment: 1
- Obesity
- Diabetes mellitus
- Immunocompromised status
These conditions contribute to both development and persistence of intertrigo, requiring closer monitoring and potentially earlier escalation to systemic therapy 1, 5.
Intertrigo with Inverse Psoriasis
When psoriasis is present in intertriginous areas, use low-potency topical corticosteroids or calcineurin inhibitors: 1
- Preferred agents: Tacrolimus 0.1% ointment or pimecrolimus 1
- Tacrolimus 0.1% achieves clear or almost clear skin in 65% of patients after 8 weeks 1
- Avoid high-potency corticosteroids in skin folds due to increased risk of atrophy and systemic absorption 1
- Calcineurin inhibitors are particularly useful for prolonged use (≥4 weeks) in thin-skinned intertriginous areas 1
Common Pitfalls to Avoid
Do not use irritant antiseptics as they may aggravate intertrigo and provoke allergic contact dermatitis 6. Focus on gentle cleansing and appropriate antimicrobial agents only when infection is present.
Address predisposing factors aggressively in recurrent cases: encourage weight loss, optimize glycemic control in diabetics, and manage intestinal colonization or periorificial infections 5. Failure to address these underlying factors leads to treatment failure and recurrence.
Educate patients about environmental precautions regarding heat, humidity, and outdoor activities 4. Physical exercise is desirable but patients must shower afterward and thoroughly dry intertriginous areas 4.