Management of Fungal Infection in Abdominal Skin Folds
Apply topical azole antifungals (clotrimazole, miconazole, ketoconazole, oxiconazole, or econazole) twice daily to the affected abdominal folds for 7-14 days, continuing for at least one week after clinical resolution, while keeping the area dry—the single most important intervention for successful treatment. 1, 2
First-Line Topical Treatment
Topical azoles are the primary treatment recommendation from the Infectious Diseases Society of America, with clotrimazole and miconazole demonstrating cure rates of 80-85% in intertriginous candidal infections. 1
Nystatin (a polyene antifungal) is equally effective as an alternative, achieving complete cure rates of 73-100% in patients with candidal skin infections in body folds. 1
Treatment duration should be 7-14 days minimum, with continuation for at least one week after all visible signs have cleared to prevent recurrence. 1
Critical Non-Pharmacologic Measures
Keeping the infected area dry is the most important intervention—more critical than the choice of antifungal agent itself. 1, 2, 3
Patients should wear light, nonconstricting, absorbent clothing and avoid wool and synthetic fibers. 4
Avoid hot showers and excessive soap use, which promote skin dehydration and worsen inflammation. 1
Do not use alcohol-containing lotions or greasy creams on inflamed intertriginous skin, as these create an occlusive environment promoting folliculitis; instead use oil-in-water creams or ointments. 1
Patients should shower after physical activity and thoroughly dry intertriginous areas. 4
When to Escalate to Oral Therapy
Consider oral fluconazole 100-200 mg daily for 7-14 days when topical therapy fails or disease is extensive. 1, 2, 3
This is particularly important for patients with obesity, diabetes mellitus, or immunocompromised status, who require more aggressive management. 2, 3
Itraconazole solution 200 mg daily is an alternative oral option for resistant cases. 2, 3
Special Considerations for High-Risk Patients
Optimize glycemic control in diabetic patients, as the American Diabetes Association and Infectious Diseases Society of America recommend this to prevent recurrence of fungal intertrigo. 1
Obesity and diabetes create persistent moisture in skin folds, making these patients more prone to treatment failure. 2, 3
Maintenance therapy with intermittent topical antifungal application should be considered for recurrent cases. 2, 3
Important Pitfalls to Avoid
Never use topical corticosteroids without dermatologic supervision in intertriginous areas, as prolonged use carries significant risk of skin atrophy in these thin-skinned regions. 1
If bacterial superinfection is suspected (increased pain, purulent discharge, rapid worsening), add topical mupirocin or clindamycin lotion. 2, 3
For MRSA involvement, consider doxycycline or trimethoprim-sulfamethoxazole. 2, 3
Clotrimazole powder (1% CP) can be used as adjuvant therapy and shows significantly higher complete cure rates within four weeks compared to cream alone, especially for dermatophyte infections. 5