Treatment of intertrigo should generally focus on the removal of predisposing factors, followed by appropriate use of topical or systemic antimicrobial agents as well as low-potency corticosteroids, if required. Despite the absence of a characteristic histopathological appearance, biopsy may be required in treatment-resistant cases of intertrigo in order to exclude other skin disorders such as psoriasis or lichen planus. Wood’s light examination can be used to identify a Pseudomonas, Malassezia, or erythrasma infection more quickly than would a culture. Microbiological cultures, potassium hydroxide (KOH) preparation, and Gram’s staining may guide the therapy when used for differentiating primary and secondary infections. 1, 2, 7ĭiagnosis of intertrigo and its complications are generally based on clinical manifestations and basic microbiological investigations. Erythema due to secondary infections, increased inflammation, papullo-pustules, and bad odor may develop. 7 Initially it presents itself as mildly erythematous papillae or plaques, quickly developing into an exudative erosion, fissures, macerations, and crusts. It generally has an insidious onset with symptoms such as itching, pain, burning, or prickling sensations in skin fold areas. Intertrigo may transform into a life-long chronic condition. 2 Many yeasts (particularly Candida) and molds, bacteria, and viral infectious agents may aggravate intertrigo by colonizing on the skin ( Table 1). Infants are also more likely to develop intertrigo due to drooling and short neck structure with prominent skin folds and a flexed position. Urinary or fecal incontinence, inadequate personal hygiene, malnutrition, immunosuppression, and occlusive clothing are among other predisposing factors. Although the condition may occur in both genders and all races, it is more common in diabetic obese individuals residing in hot and humid climates and in bed-ridden or elderly subjects. Heat, reduced aeration, humidity, and maceration facilitate intertrigo. The main factor in the development of the lesions is the mechanical friction on the skin that initially appears as a minimal erythema of the folds. Lesions mostly develop in the neck, axilla, sub-mammary fold, and perineum, while other sites may also be involved including antecubital, umbilical, perianal, and interdigital areas as well as abdominal folds, eyelids, and the retroauricular area. 1 This common skin disorder may be localized in a small area or involve larger surfaces. Intertrigo (intertriginous dermatitis) is a clinical inflammatory condition that develops in opposing skin surfaces in response to friction, humidity, maceration, or reduced air circulation. In case of predisposing immunosuppressive conditions or generalized infections, novel systemic agents with higher potency may be required. In this context, it is also possible to use magistral remedies safely and effectively. Medical treatment of candidal intertrigo usually requires topical administration of nystatin and azole group antifungals. Patients should be encouraged to lose weight, followed up properly after endocrinologic treatment and intestinal colonization or periorificial infections should be medically managed, especially in recurrent and resistant cases. The first and key step of management is identification and correction of predisposing factors. Such tests are especially useful in treatment-resistant or recurrent cases for establishing a differential diagnosis. However, a range of laboratory studies from simple tests to advanced methods can be carried out to confirm the diagnosis. The diagnosis of candidal intertrigo is usually based on clinical appearance. A multitude of predisposing factors, particularly obesity, diabetes mellitus, and immunosuppressive conditions facilitate both the occurrence and recurrence of the disease. Symptoms such as pain and itching significantly decrease quality of life, leading to high morbidity. Intertrigo is a common inflammatory dermatosis of opposing skin surfaces that can be caused by a variety of infectious agents, most notably candida, under the effect of mechanical and environmental factors.
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