Topical Antifungals Effective for Intertrigo

They include yeast-like fungi such as candida. Self-Care Guidelines Gently cleanse the affected areas daily with mild soap substitutes. The degree of inflammation is dependent upon factors such as location and duration, as well as if there is a secondary co-infection. A handout on this topic is available at https:

Candidiasis usually appears as well-defined erythema with slight scaling, often accompanied by satellite papules and pustules. No claim or opinion on these pages is intended to be medical advice or to replace a one-on-one relationship with a qualified health care professional. Increasing age is statistically significantly associated with intertrigo. Opposing skin surfaces rub against each other, at times causing erosions that become inflamed. Inverse psoriasis presents with well defined patches, but there is often less scaling than what is seen with classic plaque psoriasis. Physicians should educate patients about precautions with regard to heat, humidity, and outside activities. I have a very severe rash under one of my breasts.

What Are The Complications And Prognosis Of Candidal Skin Infections?

In intertriginous infections, exam reveals symmetrical areas of erythematous, macerated skin along skin folds. A Wood’s Lamp can be used to screen for green fluorescence of a Pseudomonas infection or coral red fluorescence of erythrasma. The following factors are considered when making this assessment and analysis. The rash can be itchy or painful, but it’s not contagious. Chronological ageing is the strongest predictor for the “natural” course of skin ageing, termed intrinsic ageing [39]. Oral ketoconazole is effective for candidal skin infections but is not recommended due to risk of liver injury.

Intertrigo (intertriginous dermatitis) is an inflammatory rash that occurs between skin folds—areas of the body where skin touches skin, such as the armpits, the groin, under breasts, or within fat folds—as a result of friction, moisture, and lack of airflow. Low-potency topical corticosteroids (class VII or VI) can be used initially to gain control. 7,8 Oral antibiotics combined with cleansing and debridement, 5 percent amikacin gel, and hot compresses of 2 to 5 percent acetic acid for 15 days may be effective. The careful clinical description of a large series of patients would be required to determine the role of these cytokines more precisely. Physical examination of the skin folds usually reveals regions of erythema with peripheral scaling. 7,8 However, gram-negative and gram-positive infections occasionally occur simultaneously in interdigital areas. The best therapy for intertrigo patients (adults and children) with GABHS may be a concomitant or independent regimen of topical therapies (e. )The patient complains of itching, stinging and burning (1).

  • Inverse psoriasis and intertrigo are both conditions that cause an itchy, inflamed rash in areas where the skin folds, such as the groin, armpit, and abdomen.
  • Residents with intertrigo were approximately 3 years older than non-affected residents, which is clinically relevant.
  • Likely, the patient will be involved in an activity that involves rubbing of their skin surfaces together.
  • Intertrigo pictures Intertrigo is common and can occur at any age, but it’s more common in the very young and in older people.

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12 Separating skin surfaces with absorbent products, such as gauze, cotton, and products with water vapor–permeable sheets, may also help reduce friction. It is also more difficult for these skin sites to heal and recover from infection, irritation, or a primary inflammatory process. One possible explanation is that skin care is not optimal in preventing this skin problem [40]. Sertaconazole nitrate also demonstrated greater antiinflammatory action than butoconazole (Gynazole-1), ciclopirox, olamine, fluconazole (Diflucan), miconazole nitrate (eg, Micatin, Neosporin AF), terconazole (Terazol 3), tioconazole (Monistat 1), or ketoconazole (Nizoral). Over time, the erythematous patch can develop erosions, macerations, fissures, crust, and weeping from the site. It also may affect antecubital fossae; umbilical, perineal, or interdigital areas; neck creases; and folds of the eyelids. Fluconazole (Diflucan), 100 to 200 mg daily for seven days, is used for resistant fungal infections, although patients who are obese may require an increased dosage. Intertrigo usually is chronic with an insidious onset of itching, burning, pain, and stinging in the skin folds.

It can involve almost any skin on the body, but most often it occurs in warm, moist, creased areas such as the armpits and groin. 2-4,6,7,10,16 View/Print Table TABLE 2 Therapeutic Modalities for Intertrigo Type of intertrigo Recommended therapy Simple intertrigo Drying agents such as talc or cornstarch; topical mild steroid lotion in cases of predominant inflammation Intertrigo infected by bacteria Topical or oral antibiotics Intertrigo infected by yeasts Topical antifungals (e. )Clotrimazole, ketoconazole, oxiconazole (Oxistat), or econazole may be used for both Candida and dermatophyte infections. Fluconazole, Itraconazole, Ketoconazole.  These include: Comments received after the deadline will be considered, but they may not be acted upon before the clinical topic is issued onto the website. If symptoms do not improve after treatment, potassium hydroxide preparation, and bacterial culture and sensitivity testing should be performed.

  • Intertrigo treatment for infants Intertrigo in babies requires special care, because the affected skin area is so delicate.
  • 3,11–18 Enlarge Print Table 2.
  • Candida albicans is the most commonly encountered pathogenic species but infections with other species can occur including C.
  • However, it may also affect interdigital spaces, perineal areas, and skin folds of the eyelids, neck, and abdomen.
  • He is given topical therapy for his rash.

When to Contact a Medical Professional

You can get access to all my hand-written hematology video notes (the notes that I use on my videos) on Patreon. Erythrasma, which is caused by Corynebacterium minutissimum, also has a predilection for intertriginous areas; it typically manifests as reddish light brown or brown, smooth to slightly scaly patches in the groin and axilla (Figure 4). The condition appears in natural and obesity-created body folds. It is a common skin condition affecting opposing cutaneous or muco-cutaneous surfaces. A characteristic rash in patients with predisposing factors is sufficient to make the diagnosis. So it's a good idea to have a dermatologist check it out. There may be maceration or erosion, which would raise the suspicion for an infectious component. Factors that increase an individual's risk of developing candidal intertrigo include:

If you have diabetes, keep it under control. For further information on contraindications, cautions, drug interactions, and adverse effects, see the electronic Medicines Compendium (eMC) or the British National Formulary (BNF). This is the first study to investigate the prevalence of intertrigo among older residents in long-term care settings in Germany. Treatment includes: Generalized itch that occurs all over the body is often more difficult to treat than localized itch. If it’s not infected, the rash is usually symmetrical. They also tend to have skin rolling against itself (like the folds of the neck), and are more likely to have damp skin from drooling and from wearing diapers. 1% Tacrolimus ointment for the treatment of Intertrigo”.

Topical barriers can be used as well. • Monthly prophylactic administration of intravenous immunoglobulin should be considered in selected patients with recurrent pneumonia. This CKS topic does not cover the management of oral or systemic candidiasis, nappy rash, candidal balanitis, candidal nail infections, or dermatophyte skin and nail infections. Skin biopsy is not useful in diagnosing candidal skin infection as there are no classic histologic findings typical of intertrigo.

Wash With Antifungal Shampoos

If the patient does not improve after a course of topical treatment, bacterial culture and sensitivity should be performed. Bacterial intertrigo treatments Topical antibiotics are used for bacterial infections. AR complete ACT1 deficiency has been reported in two patients from a consanguineous family from Algeria. Other forms of intertrigo should be considered, including: The fungus that most often causes cutaneous candidiasis is Candida albicans.

What are the clinical features of candidal intertrigo? All 3 agents have antiinflammatory properties, but a recent study showed that only sertaconazole nitrate reduces cytokine release and inhibits contact hypersensitivity and scratching (Arch Dermatol Res. )Hyperhidrosis, seen with strenuous exercise, is a prominent contributing factor in the inflammatory condition. Hot and humid environmental conditions are also aggravating conditions that contribute to the pathology. Some advocate using absorptive powders and barrier creams however there is little evidence for a benefit of these treatments. Potassium hydroxide (KOH) preparations of skin scrapings are a simple and cost-effective method of detecting candida. Candida can also cause infections of the nails, edges of the nails, and corners of the mouth.


Patients who are obese may require an increased dosage. The body normally hosts a variety of germs, including bacteria and fungi. Treatment of candidal skin infections is twofold: 3,4 Drooling also can facilitate intertrigo in infants.

Figure 2 – Candidiasis manifested on this man's torso. Discontinue if you are no better after 2 weeks of use. He reports itchiness and some irritation with movement. Preventing intertrigo Few scientific studies of intertrigo have measured what works and what doesn’t to prevent it. This term can be used to describe both inflammatory dermatoses and infectious conditions of the genitocrural and flexural skin folds. Who's at risk? 16 Cutaneous erythrasma is best managed with erythromycin (topical, applied twice daily until rash resolves, or oral, 250 mg four times daily for two weeks). Topical antifungal agents should be applied twice daily to the affected area until resolution.

How is candidal intertrigo treated?

Fungal Intertrigo Treatments

The moist and damaged skin predisposes to secondary skin infections (1). Intertrigo is a reddish rash that appears in large skin folds, where your skin surfaces rub against each other. Keep the area clean, wash it gently with a mild soap, and pat it dry.

It is likely that in aged and care dependent populations other factors might be more important. Stakeholders identified from the following groups are invited to review draft topics: Intertrigo is a fancy name for a rash that shows up between the folds of skin.

Wear Loose Clothing And Breathable Fabrics

Sometimes, these yeast penetrate beneath the surface of the skin and cause infection. “Guidelines for superficial mycotic infections of the skin: In severe cases, infected areas may ooze or emit a foul odor. 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). Symptoms of Intertrigo What does intertrigo look like? Typically, patients report redness, itching, burning, and discomfort at the site of infection. Important aspects of prescribing information relevant to primary healthcare are covered in this section specifically for the drugs recommended in this CKS topic. Figure 1 – This scaly, erythematous rash manifested under the pannus of an obese patient's stomach as a result of a candidal infection.

Schematic representation of IL-17 immunity and cooperation between cells recognizing Candida albicans (phagocytes and epithelial cells) and cells producing IL-17 cytokines (T and innate [NK] lymphocytes).
Tissue removal may be needed to allow absorption of topical antibiotic agents, which promote healing and slow the spread of infection.


Keep the areas dry and exposed to the air. Use fragrance-free soaps and other skin products to minimize irritation. Efforts to address underlying predisposing factors are important to promote resolution of infection. If overweight, weight loss is recommended. Skin infections due to bacteria or fungus can contribute to the condition. Gehrig, KA, Dinulos, JGH. Maintain a skin care routine of cleaning, moisturizing, and applying a skin barrier to protect the area. The most common areas affected include larger skin-fold areas such as:

Both recurrence and persistence of candida skin infections can occur. On the other hand, skin care dependency might also be an indicator for increased cutaneous vulnerability. Your treatment for intertrigo will depend on the cause and the type of infection you have. The inclusion of aged nursing home residents (65+ years) is another difference. The area may have an unpleasant smell.

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These drugs affect the way the immune system works. 6 Pseudomonas aeruginosa, Proteus mirabilis, or Proteus vulgaris also may occur alone or simultaneously. Infectious etiologies, either primary or secondary, should be treated with appropriate antifungal and antibacterial agents. Being more independent was protective. C 14 Skin barrier protectants, such as zinc oxide ointment and petrolatum, as part of a structured skin care routine that also includes gentle cleansing and moisturizing may reduce recurrent intertrigo infections.

I. Introduction

When to Seek Medical Care Seek medical evaluation when intertrigo does not respond to self-care measures. Candida skin infections are commonly encountered in the inpatient setting. The optimal treatment for patients with intertrigo and group A beta-hemolytic streptococcal infections includes single or multiple regimens of topical therapies (e. )It is also important to focus on gathering information regarding a history of diabetes, obesity, urinary or fecal incontinence, and immunosuppression such as human immunodeficiency virus (HIV). 2 Skin biopsy specimens usually are not required because the histology of intertrigo shows no characteristic features. Professional organizations and societies(for example, Royal Colleges). Their cellular phenotypes are characterized by impaired responses to IL-17A and IL-17F in fibroblasts and impaired responses to IL-17E in T lymphocytes. CMCD-causing gain-of-function mutations (also shown in blue) in STAT1 impair the development of IL-17–producing T cells.

Treatment includes drying agents and sometimes topical anti-inflammatory drugs. Losing some weight could certainly help in reducing the chance of further episodes. Secondary cutaneous infections can be caused by a variety of gram-positive or gram-negative bacteria or fungi, including various yeasts and dermatophytes. Create a physical barrier Depending on the affected area, use a thin cotton or gauze barrier to separate the skin folds. Therefore, this study is hypotheses generating. Your doctor can check for the presence of infection as well. Apply the barrier paste (if used) after application of these creams. The etiology and differential diagnosis for a rash at these sites is broad and can be seen in many cutaneous diseases.

Hyperinsulinemia and insulin resistance are often present in this patient population. Wash with antifungal shampoos If you have a fungal infection, try using use an antifungal shampoo (such as Nizoral AD) as soap on the affected area. ELECTROLYTES50 to get a 50% discount. Severe candidiasis can be treated with oral fluconazole, 200 mg/d for 3 days or 100 mg/d for 1 week; sometimes only one dose of fluconazole is needed to clear candidiasis. Intertrigo is most commonly seen in patients who are overweight, obese, or incontinent. 3(A case report of a 72-year-old male with SDRIFE after receiving an experimental drug infusion for the treatment of metastatic melanoma.) Drake, LA, Dinehart, SM, Farmer, ER, Goltz, RW, Graham, GF, Hordinsky, MK. The results of TEWL, SCH or pH are similar to previous research [25].

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18 The three homozygous mutations identified, Q138X, R376X and R378X, confer a loss of IL-17RC protein expression in transfected HEK293T cells, with complete abolition of the response to IL-17A and IL-17 homo- and heterodimers. As a result, bacterial superinfection can complicate a case of candida intertrigo. Potassium hydroxide (KOH) test, Gram stain, or culture is useful to exclude primary or secondary infection and to guide intertrigo therapy. Most of these candidal infections are superficial and clear up easily with treatment. By checking this box, you also agree to receive email communication from Perri Dermatology, PLLC Inc. Uncomplicated, uninfected intertrigo can be treated with barrier ointments, such as petrolatum (Vaseline) and zinc oxide (Desitin). The type of topical drug depends on whether bacteria, fungus, or yeast are involved. Sertaconazole nitrate (Ertaczo), ciclopirox (Loprox), and naftifine (Naftin) are effective against dermatophytes.

In cases of uncertainty, confirmation can be sought by way of fungal microscopy and culture of skin swabs and scrapings [7]. When to see a doctor If you or your child have a skin rash that doesn’t go away, or that rapidly gets worse, see your doctor. A skin biopsy, where they collect a small sample of the person’s skin to examine under a microscope. No doctor/patient relationship has been established by the use of this site, and no diagnosis or treatment is being provided.

The affected skin may be sensitive or painful, and severe cases can result in oozing sores, cracked skin or bleeding. Consultation with a wide range of stakeholders provides quality assurance of the topic in terms of: Basic microbiologic diagnostic studies can be performed to identify a potential causative agent of intertrigo and guide antimicrobial therapy. Skin that is exposed to urine or feces is also more vulnerable to infection.


This infection is characterized by lacy, white patches on top of reddened areas that occur on the tongue, throat or elsewhere in the mouth. • Antibiotic prophylaxis should be considered in selected patients with cutaneous staphylococcal disease. Proper identification of gram-negative organisms is critical so that effective antibiotic therapy can be initiated. Use a dehumidifier if you live in humid conditions. These may include improving glucose control in diabetics and maximizing nutritional status. It is more common among people who are overweight and thus have more skin folds. 51 Antibiotic treatment can be combined with IFN-γ injection in cases of disseminated infection. Affected areas may include:

Please help us confirm that you are not a robot and we will take you to your content. Signs and Symptoms Intertrigo is most commonly seen in skin fold areas. Inframammary (Figure 1), intergluteal, genitocrural, axillary, and/or interdigital skin folds can be involved in isolation or in combination with other body sites. Obesity and poor hygiene create a fertile environment for growth of candida, dermatophytes, and bacteria. In some people, a yeast infection, especially if it is severe and/or recurrent, may be an indication that the person has a depressed immune system.

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It most commonly occurs in the axilla, the groin, under the pannus of the stomach of obese persons (Figure 1), and the inframammary areas and other regions of the torso (Figure 2). The results of the current study do not support this finding. This is thought to arise because breakdown of skin integrity from infection allows for seeding of the blood with yeast.

Intertrigo is characterized by an intensely red, macerated, glistening rash with scaling on the edges.


The patients suffered from an unusual combination of BCGosis and mild CMC in the absence of other clinical manifestations. Invasive candidiasis, dermatophytosis, bacterial infections of the respiratory tract, and cutaneous infections caused by Staphylococcus have been reported in some patients. More potent steroids should not be used chronically, given the increased risk of skin atrophy and breakdown at these occluded sites.

It is important to treat oral disease, especially in children. Given the current level of inflammation you are experiencing I would suggest that you visit your GP who will most likely prescribe an antifungal cream containing cortisone. Please try again. Experts in the topic area.

Low potency steroids are recommended and stronger steroids preparations including those that contain both an antifungal drug and topical corticosteroid should be avoided.

In women, vaginal yeast infections are the second most common reason for vaginal burning, itching, and discharge. 18 All patients suffered from CMC, and none presented invasive or recurrent bacterial infections. The initial presentation on the skin exam is a mildly erythematous patch on both sides of the skin fold. Exercise then dry off and cool down afterward. Most often seen in the groin, axillae or in inframammary folds (1). Figure 4 – This reddish brown rash is erythrasma, which has a predilection for intertriginous areas. What is candidal intertrigo ? 1% of dermatology consultation.