Medication Summary
The goals of pharmacotherapy for intertrigo are to clear the intertrigo, reduce morbidity, and prevent complications.
Antifungal agents can be used. Their mechanism of action may involve altering RNA and DNA metabolism or intracellular accumulation of peroxide toxic to fungal cells. [21] Antibacterial agents should be used for bacterially infected intertrigo.
Immunosuppressant agents such as tacrolimus and pimecrolimus are safer than topical steroids for prolonged use or in skin folds. [17, 22]
Protective agents
Class Summary
These agents are used to protect skin against contact irritants.
Petrolatum, zinc oxide, and aluminum acetate (Triple Paste)
Triple Paste consists of petrolatum, zinc oxide paste, and aluminum acetate solution.
Mycostatin, hydrocortisone, zinc oxide (Greer goo)
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).
Zinc oxide (Desitin)
Zinc oxide is used for relief of rash, superficial wounds, and burns.
Dimethicone topical (Aveeno Baby Calming Comfort Lotion, Aveeno Baby Daily Moisture Lotion, Aveeno Daily Moisturizing Lotion)
Dimethicone is a hydrophobic barrier cream.
Antifungal agents
Class Summary
Antifungal agents exert fungicidal effects by altering the permeability of fungal cell membrane. Their mechanism of action may also involve an alteration of RNA and DNA metabolism or an intracellular accumulation of peroxide toxic to fungal cells.
Carbol-Fuchsin (Castellani Paint)
Carbol-fuchsin is a first aid antiseptic and drying agent. The active ingredient is phenol 1.5%. Inactive ingredients are water, SD alcohol 40B (13%), resorcinol, acetone, and basic fuchsin.
Miconazole (Micatin, Monistat-Derm, Monistat) cream
Miconazole damages the 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.
Clotrimazole (Lotrimin, Mycelex, Gyne-Lotrimin)
Clotrimazole is a broad-spectrum antifungal agent that inhibits yeast growth by altering cell membrane permeability, causing death of fungal cells.
Immunosuppressant agents
Class Summary
These agents exert anti-inflammatory effect by inhibiting T-lymphocyte activation. They are safer than topical steroids for prolonged use or in skin folds.
Tacrolimus ointment (Protopic)
Tacrolimus ointment is a nonsteroidal anti-inflammatory agent. It should not cause steroid-type skin atrophy. Tacrolimus ointment is currently indicated only for atopic dermatitis in nonimmunocompromised patients aged 2 years and older.
Pimecrolimus (Elidel cream 1%)
Pimecrolimus is a nonsteroidal anti-inflammatory agent. It should not cause steroid-type skin atrophy. Pimecrolimus is currently indicated only for atopic dermatitis in nonimmunocompromised patients aged 2 years and older.
Corticosteroids, Topical
Class Summary
These agents decrease the inflammatory reaction associated with intertrigo.
Hydrocortisone topical (AlaCort, AlaScalpt, Aquanil)
Lower-potency topical steroids such as hydrocortisone are useful on the face and intertriginous areas.
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Intertrigo. Courtesy of DermNet New Zealand (http://www.dermnetnz.org/assets/Uploads/fungal/candida-intertrigo/1308.jpg).
