Intertrigo
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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. Affected skin is reddened and uncomfortable. Intertrigo 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.
Cause
- Candida albicans (monilia)
- Tinea infection
- Eczema (e.g. seborrhoiec, atopic, contact)
- Psoriasis (flexural)
- Erythrasma
Symptoms
- Itchy, scaly rash
- Dry skin
- Weeping, reddened rash
- Discharging lesions
Signs
- 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
TreatmentTreatment 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-threatening 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 not responding to treatment to a dermatologist.