What is intertrigo?
Intertrigo is the term used to describe a rash in body folds or apposing skin surfaces such as axillae, groin, submammary regions, beneath an abdominal apron of fat, finger or toe web spaces.
Intertrigo affected skin is reddened and uncomfortable.
This condition is particularly common in those who are overweight and patients with diabetes mellitus.
Body folds (flexures) are prone to inflammatory rashes because of relatively high skin temperature and moisture from insensible water loss.
Sweating that is not easy to evaporate and friction from movement of adjacent skin, results in the sore skin.
Causes of Intertrigo
Intertrigo can be caused by any of the following:
- Candida albicans (monilia)
- Tinea infection
- Eczema (e.g. seborrhoiec, atopic, contact)
- Psoriasis (flexural)
- Erythrasma
Symptoms of Intertrigo
The symptoms of Intertrigo include the following:
- Itchy, scaly rash Dry skin
- Weeping, reddened rash
- Discharging lesions
Signs
The signs of Intertrigo are:
- Dry, scaly skin
- Erythema
- Excoriations
- Papules Vesicles
- Creamy satellite pustules at the margins of affected area
- Persistent brown patches
- Well-demarcated patches
- Plaques
Investigations
- Patch testing for contact dermatitis
- Skin scraping for fungal elements
- Fasting blood glucose
- Swab for culture and sensitivity
Treatment for Intertrigo
Treatment objectives
- To relieve symptoms and/or associated discomfort
- To identify and treat any predisposing factors
Non-pharmacological treatment
- Wear loose cotton clothing and open footwear for aeration of folds
- Weight loss
- Avoid precipitating factors if any
Pharmacological treatment
A. For candida intertrigo, seborrhoeic eczema or tinea infection
Evidence Rating: [C]
Miconazole 2% plus 1% hydrocortisone cream, topical,
Adults
- Apply 12 hourly for 14 days
Children
- Apply 12 hourly for 7 days
Then
Miconazole 2% cream, topical,
Adults
- Apply 12-24 hourly till rash resolves
Children
- Apply 12-24 hourly till rash resolves
Or
Clotrimazole 1% cream, topical
Adults
- Apply 12-24 hourly till rash resolves
Children
- Apply 12-24 hourly till rash resolves
Or
Miconazole, 2% powder, topical,
Adults
- Apply 12-24 hourly till rash resolves
Children
- Apply 12-24 hourly till rash resolves
Or
Clotrimazole, 1% powder, topical,
Adults
- Apply 12-24 hourly till rash resolves
Children
- Apply 12-24 hourly till rash resolves
Evidence Rating: [B]
Itraconazole, oral,
Adults
- 200 mg daily for 7 days
Children
- > 12 years; 200 mg daily for 7 days
- 1 month-12 years; 3-5 mg/kg daily for 7 days
Caution
- Use of itraconazole is associated with potentially life-threathening liver-toxicity.
- Monitor liver function while on long-term therapy.
B. For Erythrasma
Fusidic Acid, 2% cream, topical,
Adults
- Apply 6-8 hourly to affected parts
Children
- Apply 6-8 hourly to affected parts
Or
Clarithromycin, oral,
Adults
- 1g stat.
Children
- 250-500 mg stat.
Or
Erythromycin, oral,
Adults
- 500 mg 12 hourly for 5 days
Children
- 8-18 years; 250-500 mg 12 hourly for 5 days
- 2-8 years; 250 mg of syrup 12 hourly for 5 days
Or
Miconazole 2% cream, topical,
Adults
- Apply 12-24 hourly till rash resolves
Children
- Apply 12-24 hourly till rash resolves
Or
Whitfield’s ointment, topical,
Adults
- Apply 12 hourly till rash resolves
Children
- Apply 12 hourly till rash resolves
For Contact dermatitis, Atopic eczema or Flexural psoriasis
Hydrocortisone cream, 1% topical,
Adults (1-2.5% cream/ointment)
- Apply 2-3 times daily
Children (1% cream)
- > 10 years; apply thinly 12-24 hourly in area of rash for 7 days
Or
Mometasone lotion/ointment 0.1%
Adults
- Apply thinly once daily for 7 days
Children
- Apply thinly once daily for 7 days
Or
Betamethasone cream/ointment, topical,
Adults (0.05-0.1%)
- Apply thinly 12-24 hourly for 7 days
Children (0.05%) 1-18 years;
- apply thinly 12-24 hourly for 7 days
Referral Criteria
Refer patients with intertrigo who are not responding to treatment to a dermatologist.