Can Intertriginous Ulcers Be Full Thickness?
Yes, intertriginous ulcers can absolutely be full thickness, extending through the epidermis and dermis into deeper structures including subcutaneous tissue, fascia, muscle, or bone. 1
Understanding Ulcer Depth Classification
The depth of any ulcer, including those in intertriginous areas, is determined by which anatomical layers are involved:
- Superficial ulcers involve only the epidermis 1
- Partial-thickness ulcers extend through the epidermis into the dermis but do not penetrate below the dermal layer 1
- Full-thickness ulcers extend below the dermis into subcutaneous tissue, fascia, muscle, or bone 1
The key distinguishing feature of full-thickness ulcers is the presence of exposed deeper structures such as fat, fascia, muscle, tendon, or bone 1
Clinical Evidence of Full-Thickness Intertriginous Ulcers
Multiple disease processes demonstrate that intertriginous ulcers can indeed be full thickness:
Infantile Hemangiomas
Ulceration in intertriginous sites (neck, axillae, inguinal region, gluteal cleft, perineum, perianal skin) represents a major complication of segmental infantile hemangiomas, with these locations at particularly high risk 2. These ulcerated lesions can cause significant pain, bleeding, and secondary infection, indicating substantial tissue depth involvement 2
Cutaneous Crohn Disease
Cutaneous Crohn disease characteristically presents with "knife-edged" ulcerations in intertriginous spaces that can be debilitating and represent full-thickness involvement 3. These granulomatous ulcerations demonstrate the capacity for deep tissue destruction in intertriginous locations 3
Herpes Simplex Virus
Linear "knife-cut" intertriginous ulcerations related to HSV infection have been documented, particularly in immunosuppressed patients, demonstrating that infectious processes can create deep ulcerations in skin folds 4
Clinical Implications
When evaluating intertriginous ulcers, you must assess the depth carefully because:
- Moisture and friction in intertriginous areas create an environment conducive to deeper tissue breakdown 5, 6
- Secondary infections commonly complicate these ulcers and can extend the depth of tissue involvement 6
- Maceration from trapped moisture facilitates progression from superficial to deeper ulceration 5, 6
The anatomical characteristics of intertriginous areas—opposing skin surfaces with limited air circulation and increased moisture—make them particularly vulnerable to progression from superficial to full-thickness ulceration 5, 6.