What is the treatment for intertrigo?

Treatment of Intertrigo

The cornerstone of intertrigo treatment is keeping the affected area dry combined with topical antifungal agents as first-line therapy, specifically topical azoles (clotrimazole or miconazole cream) or nystatin cream/powder for candidal intertrigo. 1

Initial Management Approach

Non-Pharmacological Interventions (Essential First Step)

• Minimize moisture and friction using absorptive powders such as cornstarch or barrier creams 2
• Careful drying of skin folds is the most critical intervention and must be addressed before any pharmacological treatment will be effective 1, 3
• Patients must wear light, nonconstricting, absorbent clothing and avoid wool and synthetic fibers 2
• Shower after physical exercise and thoroughly dry intertriginous areas 2
• For toe web intertrigo specifically, wear open-toed shoes 2
• Consider moisture-wicking textiles within skin folds to reduce skin-on-skin friction and wick away moisture 4

Identify and Correct Predisposing Factors

• Obesity and diabetes mellitus require aggressive management as they significantly contribute to disease persistence and recurrence 1, 5
• Immunocompromised status necessitates more aggressive treatment approaches 1
• Address intestinal colonization or periorificial infections, especially in recurrent cases 5

Pharmacological Treatment Algorithm

First-Line: Topical Antifungals (for Candidal Intertrigo)

• Topical azoles: clotrimazole cream or miconazole cream 1, 6
• Nystatin: cream or powder formulation 1, 5
• Polyenes: amphotericin B as alternative 6
• These agents work by direct contact with the fungus and require simultaneous presence of antifungal and organism 6

Second-Line: Oral Antifungals (for Extensive or Resistant Cases)

• Fluconazole 100-200 mg daily for 7-14 days 1
• Itraconazole solution 200 mg daily 1
• Systemic agents are indicated when topical therapy fails, in cases of poor compliance, or with predisposing immunosuppressive conditions 5, 6

Bacterial Superinfection Management

• When bacterial infection is suspected, use topical antibacterial agents 1
• Mupirocin ointment or clindamycin lotion for bacterial involvement 1
• For MRSA involvement: consider doxycycline, trimethoprim-sulfamethoxazole, or other appropriate agents 1
• Treat secondary infections with antiseptics, antibiotics, or antifungals depending on identified pathogens 2

Special Considerations

Recurrent or Persistent Intertrigo

• Maintenance therapy with intermittent application of topical antifungals should be considered 1
• Investigate and eradicate sources of infection at other superficial sites 6
• Ensure proper follow-up after endocrinologic treatment in diabetic patients 5

Diagnostic Confirmation

• Clinical appearance is usually sufficient for diagnosis 5
• Laboratory studies from simple tests to advanced methods can confirm diagnosis in treatment-resistant or recurrent cases 5

Common Pitfalls to Avoid

• Do not use irritant antiseptics as they may aggravate intertrigo and provoke allergic contact dermatitis 3
• Avoid focusing solely on pharmacological treatment without addressing moisture control and predisposing factors 1, 2
• Do not overlook the need for patient education regarding heat, humidity, and activity precautions 2