Intertrigo

Updated: Mar 06, 2017
  • Author: Paras Vakharia, PharmD; Chief Editor: William D James, MD  more...
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Overview

Practice Essentials

Background

Intertrigo (intertriginous dermatitis) is an inflammatory condition of skin folds, induced or aggravated by heat, moisture, maceration, friction, and lack of air circulation.

Intertrigo frequently is worsened or colonized by infection, which most commonly is candidal but also may be bacterial or viral or due to other fungal infection.

Intertrigo commonly affects the axilla, perineum, inframammary creases, and abdominal folds, and it can also affect the neck creases and interdigital areas.

Signs and symptoms

Intertrigo usually is chronic with insidious onset of itching, burning, pain, and stinging in skin folds.

Intertrigo initially presents as mild erythematous papules and/or plaques on both sides of the skinfold. The erythematous lesions may progress to weeping, erosions, fissures, maceration, or crusting.

Worsening erythema or inflammation could suggest the development of a secondary cutaneous infection.

Etiology

Intertrigo develops from mechanical factors and secondary infection. Heat and maceration are central to the process. Opposing skin surfaces rub against each other, causing erosions that become inflamed.

Secondary cutaneous infections can be caused by a variety of gram-positive or gram-negative bacteria or fungi, including various yeasts and dermatophytes.

Diagnosis

Basic microbiologic diagnostic studies can be performed to identify a potential causative agent of intertrigo and guide antimicrobial therapy.

Potassium hydroxide (KOH) test, Gram stain, or culture is useful to exclude primary or secondary infection and to guide intertrigo therapy.

A skin biopsy generally is not required unless the intertrigo is refractory to medical treatment.

Treatment

Simple intertrigo may be treated with drying agents

Infected intertrigo should be treated with a combination of an appropriate antimicrobial agent (antifungal or antibacterial) and low-potency topical steroid. 

Prevention

During patient instruction, emphasize topics such as weight loss, glucose control (in patients with diabetes), good hygiene, and the need for daily care and monitoring. Additionally, preventative measures to reduce skin-on-skin friction and moisture in the ear, and to keep the air dry and clean, can help in the management of current intertrigo and prevent future episodes.

Complications

Since intertrigo frequently is colonized or secondarily infected, secondary cutaneous infections and acute cellulitis can occur.

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Background

Intertrigo (intertriginous dermatitis) is an inflammatory condition of skin folds, induced or aggravated by heat, moisture, maceration, friction, and lack of air circulation. [1] Intertrigo frequently is worsened or colonized by infection, which most commonly is candidal but also may be bacterial or viral or due to other fungal infection. Intertrigo commonly affects the axilla, perineum, inframammary creases, and abdominal folds, and it can also affect the neck creases and interdigital areas. [2, 3] Diaper dermatitis shows significant overlap with intertrigo. Intertrigo is a common complication of obesity and diabetes. [4]

See the image below.

Intertrigo. Courtesy of DermNet New Zealand (http: Intertrigo. Courtesy of DermNet New Zealand (http://www.dermnetnz.org/assets/Uploads/fungal/candida-intertrigo/1308.jpg).
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Pathophysiology

Intertrigo develops from mechanical factors and secondary infection. Heat and maceration are central to the process. Opposing skin surfaces rub against each other, causing erosions that become inflamed. [1] Sweat, feces, urine, and vaginal discharge may aggravate intertrigo in both adults and infants.

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Epidemiology

Frequency

Intertrigo is common, especially in hot humid environments. Intertrigo is a common complication of diabetes, and it affects most infants as a component of diaper dermatitis.

Race

Intertrigo has no racial predilection.

Sex

Intertrigo has no sex predilection, other than that from anatomic differences.

Age

Intertrigo affects people who are very old and very young because of reduced immunity, immobilization, and incontinence.

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Prognosis

With preventative measures and therapy, the prognosis for each episode of simple intertrigo is excellent; however, recurrence is common. As a complication of more serious disease, intertrigo should be considered a comorbidity. Intertrigo becomes most serious as a source of secondary infection.

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Patient Education

During patient instruction, emphasize topics such as weight loss, glucose control (in patients with diabetes), good hygiene, and the need for daily care and monitoring. [5] Additionally, preventative measures to reduce skin-on-skin friction and moisture in the ear, and to keep the air dry and clean, can help in the management of current intertrigo and prevent future episodes. [1]

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