Approach Considerations
Correcting the causative factors of intertrigo is critical.
Simple intertrigo may be treated with drying agents, while infected intertrigo should be treated with a combination of an appropriate antimicrobial agent and low-potency topical steroid.
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, wearing moisture-wicking polyester underwear and socks (eg, Orlon) 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.
Simple intertrigo may be treated with drying agents (eg, talc, cornstarch).
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, especially in the toe web spaces.
Formulations combining protective agents, antimicrobials, and topical steroids may be helpful, including the following [17, 18] :
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Triple Paste contains petrolatum, zinc oxide paste, and aluminum acetate (Burow) solution applied qs ad (ie, in a sufficient quantity).
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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 (ie, 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. Tetrix, a prescription dimethicone barrier cream, may be more protective and less greasy than traditional petrolatum-based barrier products such as zinc oxide ointment.
Intertrigo infected by bacteria should be treated with topical (eg, mupirocin) or oral antibiotics (eg, penicillin) along with low-potency topical steroids. Intertrigo infected by yeasts or dermatophytes should be treated with antifungal agents. [19] Intertrigo complicated by erythrasma should be treated with topical or oral erythromycin. [20]
Intertrigo most often involves persons who are helpless or dependent on others (eg, older persons, infants). Since intertrigo in the perineum often is complicated by incontinence, new breakthroughs in absorbent diapers have made diaper dermatitis easier to avoid. However, contact dermatitis in reaction to these diapers, whether irritant or allergic, can occur; therefore, monitor waistlines and leg openings for intertrigo.
Open-toed shoes or sandals may help reduce toe web-space moisture.
Monitor patients closely for the development of striae or a hidden infection if topical steroids are needed to control an inflammatory intertrigo.
Complications
Potential complications of therapy include contact dermatitis from topical agents and skin atrophy or striae from topical steroids.
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Intertrigo. Courtesy of DermNet New Zealand (http://www.dermnetnz.org/assets/Uploads/fungal/candida-intertrigo/1308.jpg).
