Treatment of Candidal Intertrigo
Treat candidal intertrigo with topical azoles (clotrimazole, miconazole) or nystatin applied to affected skin folds for 1-2 weeks, combined with keeping the area dry. 1, 2
First-Line Topical Therapy
The Infectious Diseases Society of America guidelines establish topical antifungals as the standard treatment for candidal intertrigo:
- Topical azoles (clotrimazole, miconazole, ketoconazole, oxiconazole, or econazole) are highly effective first-line agents 1, 3
- Nystatin (polyene antifungal) is equally effective as topical azoles, with complete cure rates of 73-100% 2
- Apply twice daily for 1-2 weeks to affected skin folds 2, 3
Essential Adjunctive Measures
Keeping the affected area dry is as important as antifungal treatment itself. 1, 2 This addresses the fundamental pathophysiology—moisture and friction in skin folds create the ideal environment for Candida growth. 3, 4
Practical moisture control strategies include:
- Use absorptive powders (cornstarch) or barrier creams 4
- Wear light, nonconstricting, absorbent clothing; avoid wool and synthetic fibers 4
- Shower after physical activity and thoroughly dry intertriginous areas 4
Diagnosis Confirmation
While candidal intertrigo is typically diagnosed clinically by the characteristic appearance of satellite lesions, confirm diagnosis with potassium hydroxide (KOH) preparation when the diagnosis is uncertain or treatment fails. 2, 3 This visualizes yeast or hyphae and helps distinguish Candida from bacterial causes of intertrigo. 2
Treatment-Resistant Cases
For resistant candidal intertrigo that fails topical therapy:
- Oral fluconazole is indicated for resistant cases 3
- Consider secondary bacterial superinfection (group A streptococcus, Corynebacterium minutissimum) which requires bacterial culture or Wood lamp examination for diagnosis 3
- Treat bacterial coinfections with topical mupirocin or oral antibiotics as appropriate 3
Address Predisposing Factors
Identification and correction of predisposing factors is the key first step in management, especially for recurrent cases. 5 Common predisposing factors include:
- Obesity - encourage weight loss 5
- Diabetes mellitus - ensure proper glycemic control with endocrinologic follow-up 5
- Immunosuppressive conditions - may require systemic antifungal therapy with novel agents 5
- Intestinal colonization or periorificial infections - treat these reservoirs in recurrent cases 5
Common Pitfalls
- Do not rely on topical therapy alone if predisposing factors remain unaddressed - recurrence is highly likely without correcting obesity, diabetes, or moisture issues 5
- Do not confuse with bacterial intertrigo - bacterial causes (streptococcal, corynebacterial) require different antimicrobial therapy 3, 4
- Do not overlook paronychia - if Candida involves nail folds, drainage is the most important intervention, combined with topical antifungals 1, 2