Intertrigo is a chronic inflammatory condition of approximating or opposing skin surfaces (intertriginous skin) such as the axillae, groin, inframammary folds, abdominal folds, and/or labiocrural folds. Clinically, there is erythema and sometimes maceration, erosions, or fissuring. The affected areas may itch or burn. Intertrigo is most frequently seen in obese and/or diabetic patients. It is induced or exacerbated by any conditions causing increased heat, wetness, and friction. It may be worse during hot and/or humid weather. Incontinence is a predisposing factor in intertrigo of the perineum and crural folds, and there is significant overlap with diaper dermatitis. There is no ethnic or sex predilection. Intertrigo is seen more frequently at the extremes of age.
Intertrigo is often complicated by superficial skin infection with yeast or bacteria. In candidal intertrigo, the presence of outlying satellite papules and/or pustules is diagnostic.
Intertrigo is irritation of touching skin surfaces in body fold regions (armpits, under the breasts, belly, buttocks, groin, and sometimes between fingers or toes). Intertrigo can be worsened by any conditions causing increased heat, wetness, and friction. Intertrigo may be complicated by superficial skin infection with yeast or bacteria.
Who’s At Risk
Intertrigo can affect people of all ages. Intertrigo is most frequently seen in overweight people, diabetics, people spending a lot of time in bed, diaper users, or anyone with incontinence problems. It can also occur in individuals wearing or using anything that causes friction or holds moisture against the skin surface.
Signs & Symptoms
Intertrigo is most commonly seen in skin fold areas. In people 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. Redness and breaks in the skin (erosions) of opposing skin surfaces may be noted. The area may ooze or be sore or itchy.
Self-Care Guidelines
Gently cleanse the affected areas daily with mild soap substitutes.
Keep the areas dry and exposed to the air. If this is not easy to do, using absorbent cotton or fabric, as well as absorbent powders, may help (as long as fabrics are changed if they become damp). Mild antiperspirants may help, but these can cause further irritation in some individuals.
Barrier creams, such as zinc oxide paste, may be helpful for individuals wearing diapers or having incontinence problems.
If overweight, weight loss is recommended.
For persistent irritation, 0.5-1.0% hydrocortisone cream twice daily may help. Discontinue if you are no better after 2 weeks of use. Adding a topical antifungal to the hydrocortisone, such as clotrimazole cream, may help if yeast infection is suspected. Apply the barrier paste (if used) after application of these creams.
When to Seek Medical Care
Seek medical evaluation when intertrigo does not respond to self-care measures.
Treatments
Low-potency topical steroid creams.
Calcineurin inhibitors (pimecrolimus cream and tacrolimus ointment), which are non-steroid topical agents, can be helpful in difficult cases.
Coexisting infection should be treated if present. In cases with limited yeast involvement, topical miconazole, clotrimazole, or ciclopirox olamine may be used. If more severe yeast involvement is noted, oral antifungal agents, such as fluconazole, may be used. Topical or oral antibiotics may be needed for bacterial infections.
A biopsy may be recommended if the diagnosis is uncertain.
References
Bolognia, Jean L., ed. Dermatology, pp.263-264. New York: Mosby, 2003.
Patient Information for Intertrigo in Adult