eMedicine Specialties > Dermatology > Environmental

Intertrigo: Treatment & Medication

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

Updated: Aug 12, 2009

Treatment

Medical Care

Correcting the causative factors of intertrigo is critical.

  • Take steps to eliminate friction, heat, and maceration by keeping folds cool and dry.
    • These steps can be accomplished by using air conditioning and absorbent powders and by exposing skin folds to the air.
    • Compresses with Burow solution 1:40, dilute vinegar, or wet tea bags often are effective, especially if followed by fanning or cool blow-drying.
    • Skin surfaces in deep folds can be kept separated with cotton or linen cloth; however, be sure to avoid tight, occlusive, or chafing clothing or dressings. Moisture-wicking  undergarments are helpful.
    • Where appropriate, antimycotic agents (miconazole, clotrimazole) are helpful, especially if used with a mild- to mid- potency (class III-VI) steroid for a short duration. Avoid using stronger topical steroids because the occlusive effect of skin folds can accelerate the development of skin atrophy and striae.
    • Castellani paint (carbol-fuchsin paint) also can be helpful.
  • Formulations combining protective agents, antimicrobials, and topical steroids may be helpful, including the following:
    • Triple Paste comprises petrolatum, zinc oxide paste, and aluminum acetate (Burow) solution applied qs ad (in a sufficient quantity).
    • Greer goo is composed of nystatin (Mycostatin) powder 4 million U, hydrocortisone powder 1.2 g, and zinc oxide paste 4 oz applied qs ad (in a sufficient quantity).
    • A thick coat of these protective barrier creams should be applied.
    • Commercially available barrier pastes sold for diaper dermatitis (eg, Desitin) can be helpful, as can absorbent diapers.
  • Open-toed shoes or sandals may help reduce toe web-space moisture.

Medication

The goals of pharmacotherapy for intertrigo are to reduce morbidity and to prevent complications.

Protective agents

Used to protect skin against contact irritants.


Petrolatum, zinc oxide, and aluminum acetate (Triple Paste)

Consists of petrolatum, zinc oxide paste, and aluminum acetate solution.

Adult

Apply thick coat as a protective barrier prn

Pediatric

Apply as in adults

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Discontinue if irritation develops; for external use only


Mycostatin, hydrocortisone, zinc oxide (Greer goo)

Consists of nystatin (Mycostatin) powder, 4 million U, hydrocortisone powder, 1.2 g, and zinc oxide paste, 4 oz qs ad (in a sufficient quantity).

Adult

Apply thick coat as a protective barrier prn

Pediatric

Apply as in adults

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Discontinue if irritation develops; for external use only


Zinc oxide, cod liver oil, and talc (Desitin)

For relief of rash, superficial wounds, and burns.

Adult

Apply thick coat as a protective barrier prn

Pediatric

Apply as in adults

Pregnancy

A - Fetal risk not revealed in controlled studies in humans

Precautions

Discontinue if irritation develops; for external use only


Dimethicone (ProShield Plus)

Hydrophobic barrier cream.

Adult

Apply a thick coat as a protective barrier prn

Pediatric

Apply as in adults

Pregnancy

A - Fetal risk not revealed in controlled studies in humans

Precautions

Discontinue if irritation develops; for external use only

Antifungal agents

Exert fungicidal effect by altering permeability of fungal cell membrane. Mechanism of action may also involve an alteration of RNA and DNA metabolism or an intracellular accumulation of peroxide toxic to fungal cells.8


Carbol-Fuchsin (Castellani Paint)

First aid antiseptic and drying agent. Active ingredient is phenol 1.5%. Inactive ingredients are water, SD alcohol 40B (13%), resorcinol, acetone, and basic fuchsin.

Adult

Apply qd or bid as drying agent

Pediatric

Apply qd or bid as drying agent

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Avoid getting on clothes; stain will slowly wear off skin


Miconazole (Micatin, Monistat-Derm, Monistat) cream

Damages fungal cell wall membrane by inhibiting biosynthesis of ergosterol. Membrane permeability is increased, causing nutrients to leak out, resulting in fungal cell death.
Lotion is preferred in intertriginous areas. If cream is used, apply sparingly to avoid maceration effects.

Adult

Apply to affected areas bid for 2-6 wk

Pediatric

Apply as in adults

Documented hypersensitivity; not recommended in first trimester of pregnancy

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Discontinue if sensitivity or chemical irritation occurs; for external use only; avoid contact with eyes; local reactions 0.5-1.5% include dyspareunia, mild vaginal or vulvar erythema, burning, pruritus, urticaria, and rash


Clotrimazole (Lotrimin, Mycelex, Gyne-Lotrimin)

Broad-spectrum antifungal agent that inhibits yeast growth by altering cell membrane permeability, causing death of fungal cells.

Adult

Gently massage into affected area and surrounding skin areas bid for 2-6 wk

Pediatric

Children: Not established
Adolescents: Administer as in adults

Documented hypersensitivity, not recommended in first trimester of pregnancy

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

For external use only; avoid contact with eyes; if irritation or sensitivity develops, discontinue use; local reactions 0.5-1.5% include dyspareunia, mild vaginal or vulvar erythema, burning, pruritus, urticaria, and rash

Immunosuppressant agents

These agents exert anti-inflammatory effect by inhibiting T-lymphocyte activation. Safer than topical steroids for prolonged use or in skin folds.9


Tacrolimus ointment (Protopic)

Nonsteroidal anti-inflammatory agent. Should not cause steroid-type skin atrophy.
Currently indicated only for atopic dermatitis in nonimmunocompromised patients >2 y.

Adult

0.1% ointment: Apply to affected areas bid for 2-6 wk

Pediatric

0.03% ointment: Apply as in adults

None reported; use caution if using oral treatments with CYP3A4 inhibitors

Documented hypersensitivity; not recommended in immunocompromised persons

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Do not use with occlusive dressings; may be associated with an increased risk of folliculitis in adults; may cause local burning sensation, stinging, soreness, or pruritus (typically improve as lesions heal); for external use only; minimize exposure to natural or artificial sunlight (eg, tanning beds or UVA/B treatment); be sure skin is completely dry before application; product insert for tacrolimus revised in January 2006 and contains a black box warning stating the long-term safety of calcineurin inhibitors has not been established; although a causal relationship has not been established, rare cases of malignancy (eg, skin, lymphoma) reported; only 0.03% ointment is indicated for use in children aged 2-15 y


Pimecrolimus (Elidel cream 1%)

Nonsteroidal anti-inflammatory agent. Should not cause steroid-type skin atrophy. Currently indicated only for atopic dermatitis in nonimmunocompromised patients >2 y. Use cream sparingly to avoid maceration in skin folds.

Adult

Apply to affected areas bid for 2-6 wk

Pediatric

Apply as in adults; indicated for >2 y

None reported; use caution if using oral treatments with CYP3A4 inhibitors

Documented hypersensitivity; not indicated in immunocompromised patients; efficacy and safety in geriatric patients not tested

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Do not use with occlusive dressings; may be associated with an increased risk of folliculitis in adults; may cause local burning sensation, stinging, soreness, or pruritus (typically improve as lesions heal); for external use only; minimize exposure to natural or artificial sunlight (eg, tanning beds or UVA/B treatment); be sure skin is completely dry before application; product insert for pimecrolimus revised in January 2006 and contains a black box warning stating the long-term safety of calcineurin inhibitors has not been established; although a causal relationship has not been established, rare cases of malignancy (eg, skin, lymphoma) reported

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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