Treatment of Groin Intertrigo
For groin intertrigo, apply topical antifungal agents (clotrimazole, miconazole, or nystatin) twice daily for 7–14 days while keeping the area dry, which is the most critical intervention for successful treatment. 1, 2
Primary Management Strategy
Moisture control is the cornerstone of treatment and must be addressed first. 2, 3 The affected groin area must be kept clean and thoroughly dry, as this is more important than any pharmacological intervention. 1, 2
Practical moisture management measures:
- Apply zinc-oxide–containing barrier creams combined with antifungal agents to maintain dryness in skin folds 3
- Use oil-in-water creams or ointments rather than alcohol-containing lotions on inflamed skin 3
- Avoid greasy creams for routine care as they create an occlusive environment promoting secondary infections 3
- Wear light, nonconstricting, absorbent clothing and avoid wool or synthetic fibers 4
- Shower after physical activity and dry intertriginous areas thoroughly 4
First-Line Pharmacological Treatment
For Candidal Intertrigo (Most Common):
Apply topical azole antifungals twice daily for 7–14 days: 1, 2, 3
- Clotrimazole cream
- Miconazole cream (achieves 80–85% cure rates in obese and diabetic patients) 3
- Ketoconazole cream
Alternative polyene option: 1, 2, 3
- Nystatin cream or powder applied twice daily for 7–14 days
Continue treatment for at least one week after clinical resolution to prevent recurrence. 3, 5
For Bacterial Superinfection:
If bacterial infection is suspected (increased pain, purulent discharge, rapid worsening): 2
- Mupirocin ointment twice daily
- Clindamycin lotion
For suspected MRSA involvement: 2
- Doxycycline or trimethoprim-sulfamethoxazole orally
Escalation to Systemic Therapy
When topical treatment fails after 7–14 days or disease is extensive, prescribe oral fluconazole 100–200 mg daily for 7–14 days. 1, 2, 3, 5 Oral fluconazole achieves 80–90% improvement rates and provides superior symptom relief compared with topical agents alone. 3
For itraconazole solution as an alternative: 200 mg daily for 7–14 days. 1, 2
Special Populations Requiring Aggressive Management
High-Risk Patients: 2, 6
- Obese individuals
- Diabetic patients (optimize glycemic control to reduce recurrence) 3, 6
- Immunocompromised patients
These patients require more aggressive initial management and closer follow-up due to higher recurrence rates. 2, 6
For Candida glabrata infections (resistant cases):
Consider longer treatment duration (14+ days) or alternative agents such as topical boric acid. 5
Critical Pitfalls to Avoid
Never use high-potency topical corticosteroids in groin skin folds without dermatologic supervision. 2, 3 This causes skin atrophy, increased systemic absorption, and worsening of fungal infections. 2, 3
Low-potency corticosteroids or calcineurin inhibitors (tacrolimus 0.1% or pimecrolimus) may be appropriate only if inverse psoriasis is confirmed, not for simple candidal intertrigo. 2
Avoid irritant antiseptics that may aggravate intertrigo and provoke allergic contact dermatitis. 7
Management of Recurrent Cases
For patients with recurrent groin intertrigo: 2, 5, 6
- Implement maintenance therapy with intermittent topical antifungal application
- Investigate and treat potential sources of reinfection (intestinal colonization, periorificial infections) 6
- Address predisposing factors: weight loss, diabetes control, immunosuppression management 6
- Consider extended prophylactic therapy 5
If no improvement after 14 days of appropriate topical therapy, switch to a different azole class or escalate to systemic therapy rather than continuing the same failed regimen. 5