What is the treatment for intertrigo?

Treatment of Intertrigo

The first-line treatment for intertrigo is keeping the affected area clean and dry combined with topical antifungal agents, as this addresses both the underlying moisture problem and the most common secondary infection (candidal). 1, 2

Primary Management Strategy

Moisture control is the cornerstone of successful treatment and must be implemented before or alongside any pharmacological intervention 2:

• Thoroughly dry intertriginous areas after bathing using separate clean towels for the groin and other body parts 1
• Use moisture-wicking textiles within skin folds to reduce skin-on-skin friction, wick away moisture, and reduce secondary infection 1, 3
• Patients should wear light, nonconstricting, absorbent clothing and avoid wool and synthetic fibers 4
• Apply absorptive powders such as cornstarch or barrier creams to minimize moisture and friction 4

Pharmacological Treatment

For Candidal Intertrigo (Most Common)

Topical antifungal agents are first-line therapy 1, 2:

• Azoles: Clotrimazole cream or miconazole cream 2
• Polyenes: Nystatin cream or powder 2, 5
• Apply to affected areas after ensuring the skin is clean and dry 2

For extensive or resistant candidal cases, escalate to oral antifungal therapy 2:

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

For Bacterial Intertrigo

When bacterial infection is suspected (increased erythema, purulent drainage, or crusting), use topical antibacterial agents 2:

• Mupirocin ointment 2
• Clindamycin lotion 2

For suspected MRSA involvement or bullous/nonbullous impetigo 2:

• Topical mupirocin or retapamulin twice daily for 5 days 2
• Consider oral doxycycline or trimethoprim-sulfamethoxazole for more extensive involvement 2

Special Populations Requiring Aggressive Management

Patients with obesity, diabetes mellitus, or immunocompromised status require more aggressive management as these conditions contribute to development and persistence of intertrigo 2, 5:

• Address underlying predisposing factors (weight loss, glycemic control, immunosuppression management) 5
• Consider maintenance therapy with intermittent application of topical antifungals for recurrent cases 2
• Properly follow up after endocrinologic treatment and manage intestinal colonization or periorificial infections in recurrent cases 5

Treatment Algorithm

1. Initial approach: Implement basic hygiene measures (keep area dry, appropriate clothing) + apply topical antifungal for suspected candidal infection OR antibacterial for suspected bacterial infection 2

2. If persistent or extensive after 1-2 weeks: Consider oral antifungal therapy (fluconazole or itraconazole) 2

3. For recurrent cases: Implement maintenance therapy with intermittent topical antifungals and investigate potential sources of reinfection 2

Intertrigo with Inverse Psoriasis

For patients with concurrent inverse psoriasis in intertriginous areas, use steroid-sparing agents 2:

• Low-potency topical corticosteroids or calcineurin inhibitors (tacrolimus 0.1% or pimecrolimus) 2
• Avoid high-potency corticosteroids in skin folds due to increased risk of atrophy and systemic absorption 2
• Tacrolimus 0.1% ointment achieves clear or almost clear skin in 65% of patients after 8 weeks and is particularly useful for prolonged use (≥4 weeks) in thin-skinned intertriginous areas 2

Common Pitfalls to Avoid

• Do not use irritant antiseptics as they may aggravate intertrigo and provoke allergic contact dermatitis 6
• Do not rely solely on topical agents without addressing moisture control and predisposing factors 4, 5
• Educate patients about precautions regarding heat, humidity, and outside activities; patients should shower after physical exercise and thoroughly dry intertriginous areas 4
• For toe web intertrigo specifically, wearing open-toed shoes can be beneficial 4