What is Intertrigo?
Intertrigo is a superficial inflammatory skin disorder caused by skin-on-skin friction in body folds, where moisture becomes trapped due to poor air circulation, creating maceration and irritation that serves as a breeding ground for secondary infections, particularly with Candida species. 1, 2
Pathophysiology and Primary Mechanism
The condition develops through a specific sequence of events:
- Mechanical friction between opposing skin surfaces creates initial irritation and damage to the skin barrier 1, 3
- Moisture accumulation occurs because air cannot circulate adequately in deep skin folds, leading to maceration of the skin 2, 4
- Secondary infection commonly follows, with Candida albicans being the predominant infectious agent (84% colonization rate in long-term care facilities) 5
- Bacterial superinfection can also occur, particularly with Staphylococcus and Streptococcus species 6
Common Anatomical Locations
Intertrigo affects areas where two skin surfaces touch:
- Axillary (armpit) regions 3
- Inframammary (under breast) areas 3
- Inguinal (groin) folds 3
- Umbilical (belly button) area 3
- Toe web spaces 4
- Any obesity-created skin folds 1
Key Risk Factors
Obesity and diabetes mellitus are the two most significant risk factors that both predispose to intertrigo and complicate its management 5, 7:
- Obesity creates additional skin folds and increases friction, with the condition being particularly common in obese individuals 1, 3
- Diabetes mellitus significantly increases risk through multiple mechanisms including impaired immune function and higher glucose levels in skin 8, 5
- Immunocompromised status (HIV, chemotherapy, immunosuppressive medications) increases both occurrence and recurrence 5, 7
- Heat and humidity exposure facilitates moisture retention 1, 4
Clinical Presentation
The condition manifests with characteristic features:
- Erythematous (red), macerated skin in opposing skin fold surfaces 2
- Pain and itching that significantly decrease quality of life 7
- Possible satellite lesions when Candida infection is present 6
- Potential for erosions, fissuring, or weeping in severe cases 2
Diagnostic Approach
Diagnosis is primarily clinical based on appearance and location, though confirmation may be needed in resistant cases 7:
- Visual inspection of characteristic distribution in skin folds 2
- Culture is not routinely recommended unless signs of secondary infection (cellulitis, fever) are present 8
- KOH preparation can confirm candidal involvement when uncertain 7
- Consider bacterial culture only if surrounding cellulitis or systemic signs develop 8
Important Clinical Pearls
Keeping the affected area dry is more critical than any topical agent and represents the cornerstone of successful management 6, 9, 5. This fundamental principle supersedes all pharmacological interventions in importance.
The condition differs from other intertriginous disorders like inverse psoriasis, hidradenitis suppurativa, or Hailey-Hailey disease, which require different management approaches 1.