Intertrigo - Causes, Symptoms & Treatment

Intertrigo is an inflammatory condition of skin fold. Intertrigo develops from mechanical factors and secondary infection. Heat and maceration are central to the process. It is a common skin condition affecting opposing cutaneous or mucocutaneous surfaces. An intertrigo sometimes refers to a bacterial, fungal, or viral infection that has developed at the site of broken skin due to such inflammation.

Intertrigo is particularly common in those who are overweight. The appearance of intertrigo is dependent on the skin area involved and the duration of inflammation. Erythema and weeping may progress to maceration and crusting. Intertrigo is an inflammation of your skin. It is caused by two surfaces of skin rubbing together. An intertrigo usually appears red and raw-looking, and may also itch, ooze, and be sore. Intertrigos occur more often among overweight individuals, those with diabetes, those restricted to bed rest or diaper use, and those who use medical devices, like artificial limbs, that trap moisture against the skin.

Intertrigo tends to occur in warm, moist areas of the body where two skin surfaces rub or press against each other. It is most common in obese individuals. The majority of cases of intertrigo can be diagnosed based on the characteristic appearance. Intertrigo is treated with antifungal creams such as clotrimazole and miconazole. Equally important in the treatment of intertrigo is keeping the skin folds as dry as possible.

This condition may also be seen in people who are restricted to bed rest or in those who wear medical devices that may trap moisture against the skin, such as artificial limbs, splints, and braces. Weight loss and frequent moving of the body are often helpful. Keeping areas of folded skin open with dry towels or blowing a fan across moist areas can also help. Loose, unrestrictive clothing should be worn. Inflammatory skin diseases are often treated with low potency topical steroid creams such as hydrocortisone. More potent steroids are usually avoided in the flexures because they may cause skin thinning resulting in stretch marks and even ulcers.

Causes of Intertrigo

Intertrigo is a yeast infection of skin folds caused by Candida albicans. It is most common in persons who are obese. Intertrigo may also be seen in people who must stay in bed or who wear medical devices that may trap moisture against the skin, such as artificial limbs, splints, and braces. The macerated skin is then easily infected with bacteria and yeast. This condition may also be seen in people who are restricted to bed rest or in those who wear medical devices that may trap moisture against the skin, such as artificial limbs, splints, and braces.

Common causes and risk factors of Intertrigo:

• Initiating factors include friction, perspiration, maceration, or irritation from stool, urine, drainage, or topical agents.
• Autoeczematization and infection.
• Fungi such as Trichophyton rubrum.
• Blistering skin disorders such as bullous pemphigoid.
• Hailey-Hailey disease.

Signs and Symptoms of Intertrigo

Intertrigo is most commonly seen in skin fold areas.  In patients who are obese, the skin my become inflamed in neck creases, on the skin behind the knee or in front of the elbows, in the thigh and groin folds, or less commonly under the breast or belly folds. Symptoms of intertrigo can appear wherever the skin falls in folds: usually around the armpits, the belly, the inner thighs, or under the breasts. Chafing causes the skin to become red. Continued chafing creates raw spots, where the skin is broken open. These areas may itch, burn, or sting.

Sign and symptoms may include the following :

• Red and moist skin.
• Sweating.
• Seborrhoeic dermatitis or thrush.
• Blisters or scales.
• Abdominal skin rash.

Treatment for Intertrigo

The most important treatment for intertrigo is to keep the area clean and dry. Your doctor may prescribe a cream to treat soreness and itching. Infections can be treated with a topical and oral medication. The most common treatment being a baby diaper rash ointment such as a topical zinc oxide cream. Also for a persistent intertrigo infection it is common for an anti-fungal cream, most commonly clotrimazole 1%, to be used in conjunction with a diaper rash ointment. Hydrocortisone cream is useful in Intertrigo treatment. It can provide temporary relief of itching. Use sparingly on facial rashes and the genitals. 

Treatment may include:

• Yeasts and fungi may be treated with topical antifungals such as clotrimazole and terbinafine cream or oral agents such as itraconazole or terbinafine.
• Sweating may be reduced with a gentle antiperspirant.
• Bacteria may be treated with topical antibiotics such as fusidic acid cream, mupirocin ointment, or oral antibiotics such as flucloxacillin and erythromycin.
• Inflammatory skin diseases are often treated with low potency topical steroid creams such as hydrocortisone.
• Calcineurin inhibitors such as tacrolimus ointment or pimecrolimus cream may also prove effective.

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