From the Guidelines
Alternative Treatments for Intertrigo
For patients with intertrigo who have failed treatment with nystatin, topical azoles such as clotrimazole 1% cream or miconazole 2% cream are effective alternatives, applied twice daily for 2-4 weeks 1, 2.
- These treatments are recommended due to their antifungal properties, which are crucial in managing intertrigo, a condition often caused by fungal infections in skin folds, especially in obese and diabetic patients.
- Keeping the infected area dry is also important, as moisture can exacerbate the infection 1, 2.
Additional Considerations
In cases where inflammation is a significant concern, a topical corticosteroid such as hydrocortisone 1% cream may be used to reduce inflammation, applied twice daily for 1-2 weeks.
- For suspected bacterial superinfection, adding a topical antibiotic like fusidic acid 2% cream, applied twice daily for 1-2 weeks, may be beneficial.
- It's essential to note that while these treatments are generally effective, the management of intertrigo should also include measures to prevent recurrence, such as maintaining good hygiene and keeping the skin folds dry 3.
From the Research
Alternative Treatments for Intertrigo
In a patient who has failed nystatin, alternative treatments for intertrigo can be considered. The following options are available:
- Topical azole group antifungals, as mentioned in the study 4
- Magistral remedies, which can be used safely and effectively, as stated in the study 4
- Sertaconazole, an imidazole antifungal agent, which has broad-spectrum antifungal activity and is effective against dermatophytes and yeasts, including Candida, as discussed in the study 5
- Terbinafine, an allylamine antifungal agent, which can be used orally for a shorter period, as shown in the study 6
- Clotrimazole, an imidazole antifungal agent, which can be used topically, as compared to terbinafine in the study 6
Key Considerations
When considering alternative treatments, it is essential to:
- Identify and correct predisposing factors, such as obesity, diabetes mellitus, and immunosuppressive conditions, as mentioned in the study 4
- Eradicate or amend predisposing factors, as stated in the study 7
- Choose a treatment that is well tolerated and effective, as discussed in the studies 5, 8, and 6
Treatment Options
The following treatment options can be considered:
- Topical sertaconazole cream, which can be used once or twice daily, as shown in the studies 5 and 8
- Oral terbinafine, which can be used for a shorter period, as compared to topical treatments, as discussed in the study 6
- Topical clotrimazole cream, which can be used twice daily, as compared to terbinafine in the study 6