Diagnostic Considerations
Differential diagnoses for intertrigo are described below. [12]
In adults, consider inflammatory diseases (common or rare), including irritant or allergic contact dermatitis, psoriasis vulgaris inversa, seborrheic dermatitis, pemphigus, atopic dermatitis, scabies, metabolic diseases, and malignancies. [13, 14] Often, these conditions also involve the skin folds. 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. [11]
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 is as follows [12] :
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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.
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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. [15]
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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.
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Postauricular fold: Consider infectious eczematoid dermatitis, sebopsoriasis, allergic contact dermatitis, or trauma resulting from wearing glasses (granuloma fissuratum).
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Axillae: Consider inverse psoriasis, erythrasma, seborrheic dermatitis, irritant or allergic contact dermatitis from deodorants/shaving, benign familial pemphigus (Hailey-Hailey disease), or axillary granuloma parakeratosis.
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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.
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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.
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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.
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Inframammillae: Consider inverse psoriasis, candidal infection, inflammatory metastatic breast cancer, Paget disease, or benign familial pemphigus (Hailey-Hailey disease).
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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, congenital syphilis, or hereditary neuroepithelial dysplasia. [16]
Differential Diagnoses
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Granular hyperkeratosis
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Psoriasis vulgaris inversa
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Intertrigo. Courtesy of DermNet New Zealand (http://www.dermnetnz.org/assets/Uploads/fungal/candida-intertrigo/1308.jpg).
