What is the treatment for intertrigo?

Treatment of Intertrigo

The cornerstone of intertrigo treatment is keeping the affected area clean and dry, combined with topical antifungal agents (azoles or polyenes) as first-line therapy for candidal intertrigo, which is the most common infectious etiology. 1, 2

Primary Management Strategy

The single most important intervention is maintaining dryness in the affected skin folds. 1, 2 This non-pharmacologic approach forms the foundation upon which all other treatments build, as moisture and friction are the primary drivers of this condition. 3

Non-Pharmacologic Measures

• Implement aggressive moisture control: Keep intertriginous areas thoroughly dry, especially after showering or physical activity 3
• Optimize clothing choices: Use light, nonconstricting, absorbent fabrics while avoiding wool and synthetic fibers 3
• Apply absorptive powders: Cornstarch or barrier creams can minimize moisture and friction 3
• Modify footwear: Open-toed shoes benefit toe web intertrigo 3

Pharmacologic Treatment Algorithm

Step 1: First-Line Topical Therapy

For suspected candidal intertrigo (most common):

• Topical azoles: Clotrimazole cream or miconazole cream 1, 2
• Topical polyenes: Nystatin cream or powder 1, 2
• Duration: Continue until complete resolution, typically 7-14 days 4

For suspected bacterial infection (look for purulence, crusting, or honey-colored exudate):

• Mupirocin ointment for typical bacterial involvement 1, 2
• Clindamycin lotion as alternative 1, 2
• For bullous or nonbullous impetigo: Topical mupirocin or retapamulin twice daily for 5 days 1

For suspected MRSA (risk factors: healthcare exposure, previous MRSA, treatment failure):

• Oral doxycycline or trimethoprim-sulfamethoxazole 1, 2

Step 2: Escalation for Extensive or Resistant Cases

When topical therapy fails or disease is extensive:

• Fluconazole 100-200 mg daily for 7-14 days 1, 2
• Itraconazole solution 200 mg daily 1, 2

The oral route is particularly important when compliance with topical agents is poor or when the affected area is too extensive for practical topical application. 4

Step 3: Maintenance Therapy for Recurrent Cases

For patients with repeated episodes:

• Intermittent application of topical antifungals to prevent recurrence 1, 2
• Investigate and eradicate sources of reinfection (intestinal colonization, periorificial infections) 5

Special Population Considerations

High-Risk Patients Requiring Aggressive Management

Patients with the following conditions need more intensive treatment and closer follow-up: 1, 2

• Obesity: Creates additional skin folds and moisture retention
• Diabetes mellitus: Impairs immune function and promotes candidal overgrowth
• Immunocompromised status: Increases risk of treatment failure and complications

These patients should be considered for earlier escalation to oral therapy and more frequent monitoring. 5

Intertrigo with Inverse Psoriasis

When psoriasis is present in intertriginous areas, the treatment approach differs significantly:

• Use low-potency topical corticosteroids or calcineurin inhibitors (tacrolimus 0.1% or pimecrolimus) as steroid-sparing agents 1
• Avoid high-potency corticosteroids in skin folds due to increased risk of atrophy and systemic absorption 1
• Tacrolimus 0.1% ointment achieves clear or almost clear skin in 65% of patients after 8 weeks 1
• Calcineurin inhibitors are preferred for prolonged use (≥4 weeks) in thin-skinned intertriginous areas 1

Common Pitfalls to Avoid

• Do not use irritant antiseptics aggressively: These may worsen intertrigo and provoke allergic contact dermatitis 6
• Do not neglect predisposing factors: Treatment will fail without addressing obesity, diabetes control, or sources of reinfection 5
• Do not assume all intertrigo is candidal: Bacterial superinfection requires different treatment, and inverse psoriasis requires corticosteroids or calcineurin inhibitors 1
• Do not use high-potency steroids in skin folds: Risk of skin atrophy and systemic absorption is significantly elevated 1