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Intertrigo: Differential Diagnoses & Workup
Updated: Aug 12, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Differential Diagnoses
Other Problems to Be Considered
Differential diagnoses for intertrigo
In the adult, consider inflammatory diseases (common or rare) including contact dermatitis, inverse psoriasis, seborrheic dermatitis, pemphigus, metabolic diseases, and malignancies.
Primary or secondary infections may be related to dermatophytes, candidal organisms, bacteria, or viruses. Possibilities involving bacteria include infection by Streptococcus and Staphylococcus species and lymphogranuloma venereum and granuloma inguinale infections.5
Metabolic disorders include toxic epidermal necrolysis, acrodermatitis enteropathica, acanthosis nigricans, and migratory epidermal necrolysis.
Malignancies include metastatic carcinoma, Paget disease, or Bowen disease.
Differential diagnosis for intertrigo by body site
Toe and finger web spaces: Consider mycotic infections, termed erosio interdigitalis blastomycetica between fingers and dermatophytosis complex between toes. Exclude interdigital hair sinuses, inverse psoriasis, gram-negative infection, or erythrasma.
Vulva: Vulvitis can occur from erythrasma, plasma cell vulvitis, adult diaper dermatitis, candidal infection, seborrheic dermatitis, psoriasis, contact dermatitis, or Jaquet "pseudowarts" resulting from chronic maceration.6
Umbilicus: Inflammation in this location is termed navelitis. Exclude seborrheic dermatitis, psoriasis, endometriosis, scabies, or the ominous Sister Mary Joseph sign (umbilical metastasis), especially if associated with blue-black induration.
Postauricular fold: Consider infectious eczematoid dermatitis, sebopsoriasis, allergic contact dermatitis, or trauma resulting from wearing glasses (granuloma fissuratum).
Axillae: Consider inverse psoriasis, erythrasma, seborrheic dermatitis, irritant or allergic contact dermatitis from deodorants, shaving, or benign familial pemphigus (Hailey-Hailey disease), or axillary granuloma parakeratosis.
Lips: Synonyms include angular stomatitis and perlèche. Consider seborrheic dermatitis; candidal infection; perioral dermatitis; irritation or allergic dermatitis from dentifrice, gum, or mouthwash; lip licker's eczema; excessive salivation from orthodontic devices; or herpes simplex labialis.
Perianal/natal cleft: Consider pruritus ani, candidal infection, contact dermatitis, anal fissures, essential fatty acid deficiency, acrodermatitis enteropathica, extramammary Paget disease, psoriasis, pilonidal cyst, decubitus dermatitis, or baboon syndrome from contact allergy systemic antibiotics, or hypovitaminosis B.
Crural fold: Alternative diagnoses include inverse psoriasis, candidal infection, adult diaper dermatitis, granuloma inguinale, pemphigus vegetans, benign familial pemphigus (Hailey-Hailey disease), toxic epidermal necrolysis, and extramammary Paget disease. A form of extensive papulonodular and eroded dermatitis in women appears to be related to overuse of topical preparations such as Vagisil.
Inframammilae: Consider inverse psoriasis, candidal infection, inflammatory metastatic breast cancer, Paget disease, or benign familial pemphigus (Hailey-Hailey disease).
Infantile intertrigo: Intertrigo in infants often is synonymous with diaper dermatitis. Exclude seborrheic dermatitis, candidal infection, psoriasis, nutritional abnormalities (biotin deficiency, acrodermatitis enteropathica from zinc deficiency, aminoaciduria related), Letterer-Siwe disease (especially if papular, eroded, or purpuric), granuloma gluteal infantum (from topical corticosteroids), impetigo, cellulitis, cystic fibrosis, congential syphilis, or hereditary neuroepithelial dysplasia.7
Workup
Laboratory Studies
- Potassium hydroxide (KOH) test, Gram stain, or culture is useful to exclude primary or secondary infection and to guide intertrigo therapy.
- Wood lamp examination can exclude erythrasma.
- Perform appropriate workup if systemic disease is suspected along with the intertrigo (diabetes, acrodermatitis enteropathica, necrolytic migratory erythema secondary to glucagonoma) or if intertrigo responds poorly to treatment.
Procedures
- Skin biopsy may help exclude inverse psoriasis, Bowen disease, Paget disease, or metastatic carcinoma.
More on Intertrigo |
| Overview: Intertrigo |
 Differential Diagnoses & Workup: Intertrigo |
| Treatment & Medication: Intertrigo |
| Follow-up: Intertrigo |
| References |
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References
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Mistiaen P, Poot E, Hickox S, Jochems C, Wagner C. Preventing and treating intertrigo in the large skin folds of adults: a literature overview. Dermatol Nurs. Feb 2004;16(1):43-6, 49-57. [Medline].
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Martin Ezquerra G, Sanchez Regana M, Herrera Acosta E, Umbert Millet P. Topical tacrolimus for the treatment of psoriasis on the face, genitalia, intertriginous areas and corporal plaques. J Drugs Dermatol. Apr 2006;5(4):334-6. [Medline].
American Academy of Family Physicians. Information from your family doctor. Intertrigo: what you should know. Am Fam Physician. Sep 1 2005;72(5):840. [Medline].
Arnold HL, Odom RB, James WD. Intertrigo. In: Andrew's Diseases of the Skin: Clinical Dermatology. 8th ed. Philadelphia, Pa: WB Saunders; 1990:285.
Clark RA, Hopkins TT. Dermatology. 3rd ed. Philadelphia, Pa: WB Saunders; 1992:485-89.
Jansen GT, Dillaha CJ, Honeycutt WM. Intertrigo. In: Clinical Dermatology. Hagerstown, Md: Harper & Row; 1979.
Kaya TI, Delialioglu N, Yazici AC, Tursen U, Ikizoglu G. Medical pearl: Blue underpants sign--a diagnostic clue for Pseudomonas aeruginosa intertrigo of the groin. J Am Acad Dermatol. Nov 2005;53(5):869-71. [Medline].
White GM. Regional Dermatology. Chicago, Ill: Mosby-Wolfe; 1994.
Further Reading
Keywords
intertrigo, skin inflammation, obesity, diabetes, heat rash, friction rash, diaper dermatitis, maceration rash
