Treatment of Intertrigo in Babies
For intertrigo in babies, apply topical antifungal agents (nystatin or clotrimazole) 2-3 times daily to affected skin folds, combined with meticulous drying and moisture control measures. 1, 2
First-Line Topical Therapy
- Nystatin cream/powder or clotrimazole cream should be applied to candidal intertrigo lesions 2-3 times daily until complete healing occurs 1, 3
- For very moist lesions, nystatin topical dusting powder is preferred over creams to minimize additional moisture 3
- Miconazole is an acceptable alternative topical agent, though nystatin and clotrimazole remain first-line 2
- Continue treatment for at least 7-14 days, extending at least one week beyond clinical resolution to prevent recurrence 2
Essential Moisture Control Measures
- Keep affected skin folds thoroughly dry - this is as important as antifungal therapy itself 1, 4
- Apply absorptive powders such as cornstarch to reduce friction and moisture in skin folds 4
- Ensure the infant wears light, nonconstricting, absorbent clothing and avoid wool or synthetic fibers 4
- After bathing, meticulously dry all intertriginous areas (neck folds, axillae, groin, diaper area) 4, 5
When to Consider Bacterial Superinfection
- If greenish-blue staining appears on clothing or the rash worsens despite antifungal therapy, suspect Pseudomonas aeruginosa superinfection 6
- Streptococcal intertrigo can cause severe inflammation in infant neck folds and requires systemic antibiotics 7
- Secondary bacterial infections occur in up to 25% of intertrigo cases and necessitate culture-directed antibiotic therapy 8
Critical Pitfalls to Avoid
- Do not use irritant antiseptics (like strong iodine solutions) on inflamed intertrigo, as these may aggravate the dermatitis or provoke allergic contact dermatitis 9
- Do not discontinue topical therapy prematurely when clinical improvement occurs - complete the full 7-14 day course 2
- Do not use systemic miconazole for prophylaxis or treatment in neonates, as this may induce fluconazole resistance 1, 2
- For otherwise healthy term infants with localized candidal intertrigo, topical therapy alone is sufficient - systemic antifungals are reserved for premature/low birth weight infants at risk for invasive candidiasis 1
Special Considerations for High-Risk Infants
- In premature neonates (<1000g) or those with prolonged rupture of membranes, widespread candidal dermatitis may herald invasive candidiasis requiring systemic therapy with amphotericin B (0.5-1 mg/kg/day) or fluconazole 1
- Healthy term infants with localized intertrigo respond well to topical therapy alone and do not require systemic antifungals 1