Intertrigo

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:

  1. Candida albicans (monilia)
  2. Tinea infection
  3. Eczema (e.g. seborrhoiec, atopic, contact)
  4. Psoriasis (flexural)
  5. Erythrasma

Symptoms of Intertrigo

The symptoms of Intertrigo include the following:

  1. Itchy, scaly rash Dry skin
  2. Weeping, reddened rash
  3. Discharging lesions

Signs

The signs of Intertrigo are:

  1. Dry, scaly skin
  2. Erythema
  3. Excoriations
  4. Papules Vesicles
  5. Creamy satellite pustules at the margins of affected area
  6. Persistent brown patches
  7. Well-demarcated patches
  8. 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

  1. To relieve symptoms and/or associated discomfort
  2. 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.