From the Guidelines
Candidal intertrigo should be treated with topical azoles and polyenes, such as clotrimazole, miconazole, and nystatin, while keeping the infected area dry. This approach is based on the guidelines for treatment of candidiasis, which emphasize the importance of topical antifungal medications and dryness in managing candidal skin infections, including intertrigo 1.
Key Treatment Considerations
- Topical azoles, including clotrimazole and miconazole, are effective treatments for candidal intertrigo
- Polyenes, such as nystatin, are also effective and can be used in combination with azoles
- Keeping the infected area dry is crucial in preventing the growth and reproduction of Candida
- Patients with diabetes should prioritize blood glucose control to prevent fungal growth ### Additional Measures
- Applying antifungal powder to absorb moisture after bathing can help keep the affected area dry
- Wearing loose-fitting, breathable cotton clothing can reduce friction and moisture accumulation
- Maintenance therapy with weekly topical applications or periodic oral antifungal treatment may be necessary for recurrent cases, as suggested by the guidelines for treatment of candidiasis 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Sufficient Econazole Nitrate Cream, 1% should be applied to cover affected areas once daily in patients with tinea pedis, tinea cruris, tinea corporis, and tinea versicolor, and twice daily (morning and evening) in patients with cutaneous candidiasis
Adults and Pediatric Patients (Neonates and Older): Apply to candidal lesions two or three times daily until healing is complete.
The treatment for Candidal intertrigo is not explicitly mentioned, but cutaneous candidiasis can be treated with:
- Econazole Nitrate Cream, 1% applied twice daily (morning and evening) for two weeks 2
- Nystatin topical dusting powder applied two or three times daily until healing is complete 3 Note that intertrigo is not directly addressed in the provided drug labels.
From the Research
Treatment Options for Candidal Intertrigo
- Topical antifungal agents such as nystatin, clotrimazole, ketoconazole, oxiconazole, or econazole are commonly used to treat fungal lesions 4
- Resistant cases of candidal intertrigo may require oral fluconazole therapy 4, 5
- The Dr Michaels® (Fungatinex®) product family, which includes a moisturising bar, topical ointment, and oral herbal formulation, has been shown to be effective in treating recalcitrant candidal intertrigo 6
- Azole antifungal creams, such as bifonazole, ketoconazole, and luliconazole, are also effective in treating cutaneous candidiasis 7
Management and Prevention
- Identifying and educating patients on reducing predisposing factors, such as moisture and friction, is important in managing and preventing intertrigo 8
- Adopting a structured skin care routine and using moisture-wicking textiles within skin folds can help reduce skin-on-skin friction and prevent secondary infection 8
- Treating secondary infections with appropriate topical agents is also crucial in managing intertrigo 4, 8
Considerations
- The diagnosis of candidal intertrigo is often based on clinical appearance, and may be confirmed using a potassium hydroxide preparation 4
- The quality of evidence for determining the strength of recommendations for practice remains low, and well-designed studies are needed to test proposed interventions and build a robust evidence base 8