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 antifungals, such as clotrimazole or miconazole, which can be used as a first-line treatment for candidal intertrigo 4, 5
- Magistral remedies, which can be used safely and effectively in the treatment of candidal intertrigo 4
- Novel systemic agents with higher potency, which may be required in cases of predisposing immunosuppressive conditions or generalized infections 4
- Adsorbent lotion containing tapioca starch, spent grain wax, Butyrospermum parkii extract, argania spinosa kernel oil, aloe barbadensis, rosehip oil, and allantoin, which has been shown to be effective in reducing pruritus and improving symptoms of intertrigo 6
- Low-potency topical corticosteroids, such as 1% hydrocortisone cream, which can be used to reduce inflammation, but may exacerbate Candida infections 6
- Oral antifungal agents, such as itraconazole, which can be used to treat candidal paronychia and onychomycosis 7
- Terbinafine hydrochloride, which can be used to treat cutaneous candidiasis and has been shown to be effective in treating interdigital tinea pedis 7, 8
Considerations for Treatment
When considering alternative treatments for intertrigo, it is essential to:
- Identify and correct predisposing factors, such as obesity, diabetes mellitus, and immunosuppressive conditions 4, 5
- Eradicate or amend predisposing factors, such as intestinal colonization or periorificial infections 4, 5
- Choose a treatment that is appropriate for the severity and location of the infection 5, 7
- Monitor for adverse effects and superimposed infections 6