Treatment of Tinea Intertrigo
For tinea intertrigo (dermatophyte infection in skin folds), topical antifungal therapy with azoles (clotrimazole, miconazole) or allylamines (terbinafine) is the first-line treatment, applied once or twice daily for 2-4 weeks, with oral therapy reserved for extensive disease or treatment failure. 1, 2, 3
Initial Treatment Approach
Topical Therapy (First-Line)
- Apply topical azoles (clotrimazole 1%, miconazole) or terbinafine 1% cream twice daily for 2-4 weeks 1, 2
- Terbinafine cream requires shorter treatment duration (1-2 weeks) compared to azoles (4 weeks) and demonstrates superior mycological cure rates (93.5% vs 73.1% for clotrimazole) 4, 2
- Continue treatment for at least one week after clinical clearing to prevent relapse 2
- Keep the infected area dry—this is critical for treatment success in intertrigo 5
When to Use Oral Therapy
Oral antifungals are indicated when: 2, 3, 6
- The infection is extensive or covers large body surface area
- Topical treatment has failed after 2-4 weeks
- The patient is immunocompromised
- Application of topical agents is not feasible
Oral Therapy Options (Second-Line)
If oral therapy is required: 7, 3
- Itraconazole 100 mg daily for 15 days (87% mycological cure rate) 7
- Terbinafine 250 mg daily for 1-2 weeks (particularly effective against Trichophyton tonsurans) 7, 3
Critical Adjunctive Measures
Eliminate Predisposing Factors
- Address skin moisture and maceration in skin folds 5, 1
- Manage obesity and diabetes if present 5
- Use absorbent powders or barrier creams to keep areas dry 5
Prevent Reinfection
- Clean contaminated fomites (towels, clothing) with disinfectant or 2% sodium hypochlorite solution 8, 7
- Avoid sharing personal items 7
- Screen and treat household contacts if anthropophilic species (T. tonsurans) is identified 8, 7
Diagnostic Confirmation
- Obtain potassium hydroxide (KOH) preparation or culture before treatment when diagnosis is uncertain 2, 6
- This distinguishes tinea from candidal intertrigo, which requires different treatment 5
- For candidal intertrigo, topical azoles and polyenes (nystatin) are effective, but the clinical approach differs 5
Treatment Monitoring
- Assess both clinical response and mycological cure—clinical clearing alone is insufficient 8, 7
- If clinical improvement occurs but infection persists, extend treatment for 2-4 additional weeks 9, 8
- If no improvement after 2-4 weeks of topical therapy, switch to oral antifungals 7, 3
Common Pitfalls to Avoid
- Do not confuse tinea intertrigo with candidal intertrigo—both occur in skin folds but require different treatments 5, 1
- Avoid stopping treatment when symptoms resolve; continue for at least one week after clinical clearing 2
- Do not use topical corticosteroids alone, as they can worsen fungal infections; combination antifungal/steroid products should be used cautiously and only when significant inflammation is present 2
- Search for other sites of tinea infection and treat simultaneously to prevent reinfection 1