History
Intertrigo usually is chronic with an insidious onset of itching, burning, pain, and stinging in skin folds. When acute discomfort is noted, consider secondary infection. [7]
Intertrigo commonly is seasonal, associated with heat and humidity or strenuous activity in which chafing or skin-on-skin friction 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 Examination
The appearance of intertrigo is dependent on the skin area involved and the duration of inflammation. Intertrigo initially presents as mild erythematous patches 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. [1, 7]
Pustules or vesicles may herald infection. In the perineum, depths of the skin folds are involved compared with purely irritant diaper dermatitis in which only convex surfaces are involved. Bluish-green staining of the diaper or underclothing may indicate pseudomonal intertrigo, which can be treated with vinegar soaks. [8, 9] Intertrigo infected by candidal species often presents with satellite lesions.
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.
Complications
Since intertrigo frequently is colonized or secondarily infected, secondary cutaneous infections and acute cellulitis are threats to occur. [10] These secondary cutaneous infections can be caused by a variety of gram-positive or gram-negative bacteria or fungi, including various yeasts and dermatophytes. [11] An infectious intertrigo may result in serious cellulitis, especially in patients who are diabetic. Additionally, skin fissuring and ulceration can occur, possibly hidden in the deep skin folds of persons who are obese, which can lead to pain, disability, and, potentially, sepsis.
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Intertrigo. Courtesy of DermNet New Zealand (http://www.dermnetnz.org/assets/Uploads/fungal/candida-intertrigo/1308.jpg).
