eMedicine Specialties > Dermatology > Environmental

Intertrigo

Author: Samuel Selden, MD, Assistant Professor, Department of Dermatology, Eastern Virginia Medical School
Contributor Information and Disclosures

Updated: Aug 12, 2009

Introduction

Background

Intertrigo 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, fungal, or viral. Intertrigo commonly affects the axilla, perineum, inframammary creases, and abdominal folds.1,2  Diaper dermatitis shows significant overlap with intertrigo. Intertrigo is a common complication of obesity and diabetes.3

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. Sweat, feces, urine, and vaginal discharge may aggravate intertrigo in both adults and infants.

Frequency

International

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.

Mortality/Morbidity

As a complication of more serious disease, intertrigo should be considered a comorbidity. Intertrigo becomes most serious as a source of secondary infection.

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.

Clinical

History

  • Intertrigo usually is chronic with insidious onset of itching, burning, and stinging in skin folds.
  • When acute discomfort is noted, consider secondary infection.
  • Intertrigo commonly is seasonal, associated with heat and humidity or strenuous activity in which chafing occurs.
  • In addition to obesity and diabetes, hyperhidrosis may be a risk factor for intertrigo.
  • Additional factors that predispose individuals to perineal intertrigo include urinary or fecal incontinence, vaginal discharge, or a draining wound.

Physical

  • The appearance of intertrigo is dependent on the skin area involved and the duration of inflammation. Erythema and weeping may progress to maceration and crusting. Fissuring may follow erosion. Pustules or vesicles may herald infection. In the perineum, depths of the skin folds are involved compared to purely irritant diaper dermatitis in which only convex surfaces are involved.
  • Any skin fold may be involved with intertrigo. In adults or infants who are obese, skin folds are accentuated, and inflammation may occur under pendulous abdominal folds, in neck creases, or in popliteal or antecubital fossae.
  • As the mandible shrinks in elderly persons and the vertical dimensions decrease around the mouth, inflammation and candidiasis can occur under the accentuated nasolabial fold that develops.

Causes

  • Initiating factors include friction, perspiration, maceration, or irritation from stool, urine, drainage, or topical agents.
  • Autoeczematization and infection also may be factors in intertrigo.
  • Whether infectious agents play a primary role in intertrigo or simply are common secondary agents is controversial.4

More on Intertrigo

Overview: Intertrigo
Differential Diagnoses & Workup: Intertrigo
Treatment & Medication: Intertrigo
Follow-up: Intertrigo
References
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References

  1. Weston WL, Lane AT, Weston JA. Diaper dermatitis: current concepts. Pediatrics. Oct 1980;66(4):532-6. [Medline].

  2. English JC III, Derdeyn AS, Wilson WM, Patterson JW. Axillary granuloma parakeratosis. J Cutan Med Surg. 2003;7(4):330-332.

  3. Hahler B. An overview of dermatological conditions commonly associated with the obese patient. Ostomy Wound Manage. Jun 2006;52(6):34-6, 38, 40 passim. [Medline].

  4. 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].

  5. Honig PJ, Frieden IJ, Kim HJ, Yan AC. Streptococcal intertrigo: an underrecognized condition in children. Pediatrics. Dec 2003;112(6 Pt 1):1427-9. [Medline].

  6. Mommers JM, Seyger MM, van der Vleuten CJ, van de Kerkhof PC. Interdigital psoriasis (psoriasis alba): renewed attention for a neglected disorder. J Am Acad Dermatol. Aug 2004;51(2):317-8. [Medline].

  7. Bjornsdottir S, Gottfredsson M, Thorisdottir AS, et al. Risk factors for acute cellulitis of the lower limb: a prospective case-control study. Clin Infect Dis. Nov 15 2005;41(10):1416-22. [Medline].

  8. Dogan B, Karabudak O. Treatment of candidal intertrigo with a topical combination of isoconazole nitrate and diflucortolone valerate. Mycoses. Sep 2008;51 Suppl 4:42-3. [Medline].

  9. 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].

  10. 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].

  11. Arnold HL, Odom RB, James WD. Intertrigo. In: Andrew's Diseases of the Skin: Clinical Dermatology. 8th ed. Philadelphia, Pa: WB Saunders; 1990:285.

  12. Clark RA, Hopkins TT. Dermatology. 3rd ed. Philadelphia, Pa: WB Saunders; 1992:485-89.

  13. Jansen GT, Dillaha CJ, Honeycutt WM. Intertrigo. In: Clinical Dermatology. Hagerstown, Md: Harper & Row; 1979.

  14. 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].

  15. White GM. Regional Dermatology. Chicago, Ill: Mosby-Wolfe; 1994.

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Further Reading

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Keywords

intertrigo, skin inflammation, obesity, diabetes, heat rash, friction rash, diaper dermatitis, maceration rash

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Contributor Information and Disclosures

Author

Samuel Selden, MD, Assistant Professor, Department of Dermatology, Eastern Virginia Medical School
Samuel Selden, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Astellas Pharma US, Inc. Honoraria Consulting; Galderma Laboratories, L.P. Honoraria Review panel membership

Medical Editor

Franklin Flowers, MD, Chief, Division of Dermatology, Professor, Department of Medicine and Otolaryngology, University of Florida College of Medicine
Franklin Flowers, MD is a member of the following medical societies: American College of Mohs Micrographic Surgery and Cutaneous Oncology
Disclosure: Nothing to disclose.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Paul Krusinski, MD, Director of Dermatology, Professor, Department of Internal Medicine, Fletcher Allen Health Care, University of Vermont
Paul Krusinski, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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