What alternatives can be used instead of InterDry® for treating intertrigo (skin‑fold dermatitis) in adult or elderly patients?

Alternatives to InterDry® for Intertrigo Management

For treating intertrigo (skin-fold dermatitis), use topical antifungal agents—specifically clotrimazole, miconazole, ketoconazole, oxiconazole, or econazole applied twice daily for 7-14 days—combined with moisture-wicking barrier strategies and keeping affected areas dry. 1

First-Line Topical Antifungal Treatment

The Infectious Diseases Society of America provides clear guidance on antifungal selection for fungal intertrigo:

• Apply topical azole antifungals (clotrimazole, miconazole, ketoconazole, oxiconazole, or econazole) twice daily to affected areas for a minimum of 7-14 days, continuing for at least one week after clinical resolution 1
• Nystatin is equally effective as an alternative polyene antifungal for candidal intertrigo, with complete cure rates of 73-100% 1
• Miconazole demonstrates particularly high efficacy with cure rates of 80-85% in patients with obesity and diabetes, especially in intertriginous areas 1

Essential Moisture Management Strategies

Keeping the infected area dry is crucial for successful treatment and can hinder outcomes if neglected 1. The Annals of Oncology recommends:

• Avoid hot showers and excessive soap use, which promote skin dehydration 1
• Do not use alcohol-containing lotions or gels on inflamed intertriginous skin 1
• Use oil-in-water creams or ointments instead 1
• Patients should wear light, nonconstricting, and absorbent clothing while avoiding wool and synthetic fibers 2

Barrier and Moisture-Wicking Products

For non-pharmacologic moisture control:

• Use absorptive powders such as cornstarch or barrier creams to minimize moisture and friction 2
• Consider moisture-wicking textiles within skin folds to reduce skin-on-skin friction, wick away moisture, and reduce secondary infection 3
• Apply emollients liberally (at least twice daily) to maintain skin barrier function, with cream or ointment formulations preferred over alcohol-containing lotions 4

Topical Corticosteroids for Inflammation

When significant inflammation is present:

• Apply hydrocortisone 1-2.5% cream to affected areas not more than 3 to 4 times daily for adults and children 2 years and older 5
• Mild potency corticosteroids like hydrocortisone are appropriate for intertriginous areas where skin is thinner 4
• Continue until inflammation resolves, typically 2-6 weeks 4

Common pitfall: Avoid using greasy creams for basic care, as they may facilitate folliculitis development due to occlusive properties 6. Also avoid topical steroids without dermatologic supervision in these areas due to risk of skin atrophy with prolonged use 6.

When to Escalate to Systemic Therapy

For extensive disease or topical treatment failure:

• Consider oral fluconazole 100-200 mg daily for 7-14 days when topical therapy fails or disease is extensive 1
• Optimize glycemic control in diabetic patients to prevent recurrence 1

Secondary Bacterial Infection Management

If bacterial superinfection is suspected (erythema with peripheral scaling, satellite lesions):

• Treat secondary streptococcal infections with topical mupirocin or oral penicillin 7
• Treat Corynebacterium infections with oral erythromycin 7
• Diagnosis may be confirmed using potassium hydroxide preparation for fungal infections or bacterial culture for bacterial infections 7

Practical Treatment Algorithm

1. Identify and address predisposing factors (obesity, diabetes, moisture exposure) 3
2. Initiate moisture control measures immediately (absorptive powders, moisture-wicking textiles, proper clothing) 2, 3
3. Apply topical azole antifungal twice daily (clotrimazole, miconazole, or alternatives) for minimum 7-14 days 1
4. Add hydrocortisone 1-2.5% cream up to 3-4 times daily if significant inflammation present 5
5. Continue treatment for at least one week after clinical resolution to prevent recurrence 1
6. Escalate to oral fluconazole 100-200 mg daily if topical therapy fails after 2 weeks 1