From the Guidelines
Intertrigo should be treated with topical azoles and polyenes, including clotrimazole, miconazole, and nystatin, while keeping the infected area dry, as this approach is effective in managing the condition, especially in obese and diabetic patients 1. To manage intertrigo, it is essential to keep the affected skin folds clean and dry by gently washing with mild soap, thoroughly drying the area, and using absorbent powders like zinc oxide or cornstarch.
- For mild cases, apply barrier creams containing zinc oxide or petrolatum to protect the skin.
- If inflammation is present, use low-potency topical corticosteroids like hydrocortisone 1% cream twice daily for up to 7 days.
- For fungal infections, apply antifungal creams such as clotrimazole or miconazole twice daily for 2-4 weeks, as recommended by guidelines for treating candidiasis 1.
- Bacterial infections may require topical antibiotics like mupirocin or oral antibiotics if severe. Prevention involves wearing loose-fitting, breathable clothing, maintaining a healthy weight, and using moisture-wicking fabrics. Intertrigo develops because skin-on-skin friction damages the skin barrier, while heat and moisture create an environment where microorganisms thrive, leading to the characteristic redness, maceration, and sometimes painful erosions in skin folds. The most recent and highest quality study 1 supports the use of topical azoles and polyenes, making it the preferred treatment option for intertrigo.
From the Research
Definition and Causes of Intertrigo
- Intertrigo is a superficial inflammatory dermatitis occurring on two closely opposed skin surfaces as a result of moisture, friction, and lack of ventilation 2.
- It is caused by skin-on-skin friction in skin folds, due to moisture becoming trapped because of poor air circulation 3, 4.
- Bodily secretions, including perspiration, urine, and feces, often exacerbate skin inflammation 2.
Diagnosis of Intertrigo
- Physical examination of skin folds reveals regions of erythema with peripheral scaling 2.
- Candidal intertrigo is commonly diagnosed clinically, based on the characteristic appearance of satellite lesions 2.
- Diagnosis may be confirmed using a potassium hydroxide preparation 2.
- Bacterial superinfections may be identified with bacterial culture or Wood lamp examination 2.
Treatment of Intertrigo
- Fungal lesions are treated with topical nystatin, clotrimazole, ketoconazole, oxiconazole, or econazole 2.
- Secondary streptococcal infections are treated with topical mupirocin or oral penicillin 2.
- Corynebacterium infections are treated with oral erythromycin 2.
- A topical antifungal agent is the first choice to treat Candida intertrigo 5.
- Infection to Malassezia spp. are treated topically with azoles or selenium sulphur 5.
Prevention and Management of Intertrigo
- Identify predisposing factors and educate patient in reducing these 3.
- Educate patients in skin fold management and adopt structured skin care routine 3.
- Consider using moisture-wicking textiles within skin folds to reduce skin-on-skin friction, wick away moisture and reduce secondary infection 3.
- Investment in the development and adoption of clear skin care and skin fold management protocols can lead to improvements in the patient experience and better clinical outcomes 4.