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.