Intertrigo
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Intertrigo (intertriginous dermatitis) is an inflammatory condition of skin folds, induced or aggravated by heat, moisture, maceration, friction, and lack of air circulation.
Intertrigo frequently is worsened by infection, which most commonly is with Candida species. Bacterial, viral, or other fungal infection may also occur.
Intertrigo commonly affects the axilla, perineum, inframammary creases, and abdominal folds. Uncommonly, it can also affect the neck creases and interdigital areas.
Intertrigo usually is chronic with an insidious onset of itching, burning, pain, and stinging in the skin folds.
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.
Intertrigo develops from mechanical factors and secondary infection. Heat and maceration are central to the process. Opposing skin surfaces rub against each other, at times causing erosions that become inflamed.
Secondary cutaneous infections can be caused by a variety of gram-positive or gram-negative bacteria or fungi, including various yeasts and dermatophytes.
Basic microbiologic diagnostic studies can be performed to identify a potential causative agent of intertrigo and guide antimicrobial therapy.
Potassium hydroxide (KOH) test, Gram stain, or culture is useful to exclude primary or secondary infection and to guide intertrigo therapy.
A skin biopsy generally is not required unless the intertrigo is refractory to medical treatment.
Simple intertrigo may be treated with drying agents
Infected intertrigo should be treated with a combination of an appropriate antimicrobial agent (antifungal or antibacterial) and low-potency topical steroid.
During patient instruction, emphasize topics such as weight loss, glucose control (in patients with diabetes), good hygiene, and the need for daily care and monitoring. Additionally, preventative measures to reduce skin-on-skin friction and moisture can help in the management of current intertrigo and prevent future episodes.
Since intertrigo frequently is colonized or secondarily infected, secondary cutaneous infections and acute cellulitis can occur.
Intertrigo (intertriginous dermatitis) is an inflammatory condition of skin folds, induced or aggravated by heat, moisture, maceration, friction, and lack of air circulation. [1] Intertrigo frequently is worsened by infection, which most commonly is with Candida. Bacterial, viral or, other fungal infection may also occur. Intertrigo commonly affects the axilla, perineum, inframammary creases, and abdominal folds, and it can also affect the neck creases and interdigital areas. [2, 3] Diaper dermatitis shows significant overlap with intertrigo. Intertrigo is a common complication of obesity and diabetes. [4]
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Intertrigo develops from mechanical factors and secondary infection. Heat and maceration are central to the process. Opposing skin surfaces rub against each other, at times causing erosions that become inflamed. [1] Sweat, feces, urine, and vaginal discharge may aggravate intertrigo in both adults and infants.
Intertrigo is common, especially in hot humid environments. Intertrigo is a common complication of diabetes, and it affects many infants as a component of diaper dermatitis.
Intertrigo has no racial predilection.
Intertrigo has no sex predilection.
Intertrigo affects people who are very old and very young because of reduced immunity, immobilization, and incontinence.
With preventative measures and therapy, the prognosis for each episode of simple intertrigo is excellent; however, recurrence is common. As a complication of more serious disease, intertrigo should be considered a comorbidity. Intertrigo becomes most serious as a source of secondary infection.
During patient instruction, emphasize topics such as weight loss, glucose control (in patients with diabetes), good hygiene, and the need for daily care and monitoring. [5] Additionally, preventative measures to reduce skin-on-skin friction and moisture can help in the management of current intertrigo and prevent future episodes. [1]
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Weston WL, Lane AT, Weston JA. Diaper dermatitis: current concepts. Pediatrics. 1980 Oct. 66(4):532-6. [Medline].
English JC 3rd, Derdeyn AS, Wilson WM, Patterson JW. Axillary granular parakeratosis. J Cutan Med Surg. 2003 Jul-Aug. 7 (4):330-2. [Medline].
Hahler B. An overview of dermatological conditions commonly associated with the obese patient. Ostomy Wound Manage. 2006 Jun. 52(6):34-6, 38, 40 passim. [Medline].
American Academy of Family Physicians. Information from your family doctor. Intertrigo: what you should know. Am Fam Physician. 2005 Sep 1. 72(5):840. [Medline].
Guitart J, Woodley DT. Intertrigo: a practical approach. Compr Ther. 1994. 20 (7):402-9. [Medline].
Kalkan G, Duygu F, Bas Y. Greenish-blue staining of underclothing due to Pseudomonas aeruginosa infection of intertriginous dermatitis. J Pak Med Assoc. 2013 Sep. 63(9):1192-4. [Medline].
Kaya TI, Delialioglu N, Yazici AC, Tursen U, Ikizoglu G. Medical pearl: Blue underpants sign–a diagnostic clue for Pseudomonas aeruginosa intertrigo of the groin. J Am Acad Dermatol. 2005 Nov. 53(5):869-71. [Medline].
Ndiaye M, Taleb M, Diatta BA, Diop A, Diallo M, Diadie S, et al. [Etiology of intertrigo in adults: A prospective study of 103 cases]. J Mycol Med. 2016 Aug 20. [Medline].
Vanhooteghem O, Szepetiuk G, Paurobally D, Heureux F. Chronic interdigital dermatophytic infection: a common lesion associated witih potentially severe consequences. Diabetes Res Clin Pract. Jan. 2011. 91(1):23-5. [Medline].
Honig PJ, Frieden IJ, Kim HJ, Yan AC. Streptococcal intertrigo: an underrecognized condition in children. Pediatrics. 2003 Dec. 112(6 Pt 1):1427-9. [Medline].
Syed ZU, Khachemoune A. Inverse psoriasis: case presentation and review. Am J Clin Dermatol. 2011 Apr 1. 12(2):143-6. [Medline].
Laube S, Farrell AM. Bacterial skin infections in the elderly: diagnosis and treatment. Drugs Aging. 2002. 19 (5):331-42. [Medline].
Wilmer EN, Hatch RL. Resistant “candidal intertrigo”: could inverse psoriasis be the true culprit?. J Am Board Fam Med. 2013 Mar-Apr. 26 (2):211-4. [Medline].
Mommers JM, Seyger MM, van der Vleuten CJ, van de Kerkhof PC. Interdigital psoriasis (psoriasis alba): renewed attention for a neglected disorder. J Am Acad Dermatol. 2004 Aug. 51(2):317-8. [Medline].
Bjornsdottir S, Gottfredsson M, Thorisdottir AS, et al. Risk factors for acute cellulitis of the lower limb: a prospective case-control study. Clin Infect Dis. 2005 Nov 15. 41(10):1416-22. [Medline].
Del Rosso JQ. Adult seborrheic dermatitis: a status report on practical topical management. J Clin Aesthet Dermatol. 2011 May. 4(5):32-8. [Medline]. [Full Text].
Hoeger PH, Stark S, Jost G. Efficacy and safety of two different antifungal pastes in infants with diaper dermatitis: a randomized, controlled study. J Eur Acad Dermatol Venereol. 2010 Sep. 24(9):1094-8. [Medline].
Kalra MG, Higgins KE, Kinney BS. Intertrigo and secondary skin infections. Am Fam Physician. 2014 Apr 1. 89 (7):569-73. [Medline].
Holdiness MR. Management of cutaneous erythrasma. Drugs. 2002. 62 (8):1131-41. [Medline].
Dogan B, Karabudak O. Treatment of candidal intertrigo with a topical combination of isoconazole nitrate and diflucortolone valerate. Mycoses. 2008 Sep. 51 Suppl 4:42-3. [Medline].
Martin Ezquerra G, Sanchez Regana M, Herrera Acosta E, Umbert Millet P. Topical tacrolimus for the treatment of psoriasis on the face, genitalia, intertriginous areas and corporal plaques. J Drugs Dermatol. 2006 Apr. 5(4):334-6. [Medline].
James WD, Berger T, Elston DM. Andrew’s Diseases of the Skin: Clinical Dermatology. 12th ed. Philadelphia, Pa: Saunders Elsevier; 2015.
Paras Vakharia, PharmD Medical Student Researcher, Department of Dermatology, Henry Ford Hospital; Medical Student Researcher, Department of Ophthalmology and Department of Radiation Oncology, Oakland University William Beaumont School of Medicine
Paras Vakharia, PharmD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, American Heart Association, American Medical Association, American Society of Hematology, Michigan State Medical Society
Disclosure: Nothing to disclose.
Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society
Disclosure: Nothing to disclose.
Paul Krusinski, MD Director of Dermatology, Fletcher Allen Health Care; Professor, Department of Internal Medicine, University of Vermont College of Medicine
Paul Krusinski, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, Society for Investigative Dermatology
Disclosure: Nothing to disclose.
William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine
William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology
Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD.
Franklin Flowers, MD Department of Dermatology, Professor Emeritus Affiliate Associate Professor of Pathology, University of Florida College of Medicine
Franklin Flowers, MD is a member of the following medical societies: American College of Mohs Surgery
Disclosure: Nothing to disclose.
Samuel T Selden, MD Assistant Professor Department of Dermatology Eastern Virginia Medical School; Consulting Staff, Chesapeake General Hospital; Private Practice
Samuel T Selden, MD is a member of the following medical societies: American Academy of Dermatology, International Society of Geriatric Dermatology
Disclosure: Nothing to disclose.
Intertrigo
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