Intertrigo

1. See Also
   1. Cutaneous Candidiasis
   2. Cellulitis
   3. Tinea Pedis
   4. Tinea Cruris
   5. Angular Cheilitis
   6. Diaper Dermatitis
   7. Erythrasma
2. Definition
   1. Inflammation and secondary infection at skinfolds
3. Pathophysiology
   1. Friction between skin at folds
   2. Moisture increased and air flow decreased
   3. Conditions allow for secondary superinfection
4. Risk Factors
   1. Obesity
   2. Diabetes Mellitus
   3. Incontinence of urine or stool
   4. Hyperhidrosis
   5. Poor hygiene
5. Organisms
   1. Fungus
      1. Candidiasis (most common)
      2. Dermatophytes
         1. See Tinea Pedis and Tinea Cruris
   2. Bacteria
      1. Staphylococcus aureus
      2. Beta-hemolytic Streptococcus
      3. Pseudomonas aeruginosa
      4. Proteus mirabilis
      5. Proteus vulgaris
      6. Corynebacterium minutissimum (Erythrasma)
6. Distribution
   1. Most common sites
      1. Groin
      2. Axillae
      3. Inframammary folds
      4. Interdigital toe web space
         1. Athletes, laborers with closed-toe or tight shoes
   2. Less common sites
      1. Antecubital or popliteal fossa
      2. Umbilicus
      3. Perineum
      4. Neck area in infacts
      5. Angular Cheilitis
7. Symptoms
   1. Itching, burning, and redness in affected skin fold
   2. Foul odor may be present
8. Signs
   1. Starts with mild erythema
   2. Later, area may become eroded, macerated, fissured
9. Labs
   1. Potassium Hydroxide (KOH) for fungal organisms
   2. Wood's Lamp Examination
      1. Pseudomonas fluoresces green
      2. Erythrasma fluoresces coral-red
10. Differential Diagnosis
    1. Contact Dermatitis (Irritant or allergic)
    2. Atopic Dermatitis
    3. Seborrheic Dermatitis
    4. Psoriasis
    5. Pemphigus Vegetans
11. Management
    1. General
       1. Eliminate skin friction
       2. Eliminate moisture in skin folds (e.g. Talc)
       3. Barrier ointment (e.g. Petroleum Jelly)
       4. Wear light, breathable, or absorbent clothing
    2. Treat infection
       1. Antifungals
          1. First-line: Topical Antifungals
             1. Imidazole (e.g. Clotrimazole) cover all fungus
             2. Nystatin for Cutaneous Candidiasis
          2. Second-line: Broad-spectrum Topical Antifungals
             1. Naftifine (Naftin)
             2. Terbinafine (Lamisil)
             3. Ciclopirox (Loprox)
             4. Butenafine (Mentax)
          3. Third-line: Oral Antifungals
             1. Fluconazole (Diflucan)
             2. Itraconazole (Sporanox)
       2. Antibiotics for Streptococcus or Staphylococcus
          1. Also see Erythrasma and Tinea Pedis
          2. Topical Mupirocin (Bactroban)
          3. Oral antibiotics (Dicloxacillin or Cephalexin)
          4. Consider in combination with 1% Hydrocortisone
12. Prevention
    1. Keep intertriginous areas clean and dry
    2. Weight loss
    3. Avoid heat and humidity
    4. Wear open-toe shoes
13. References
    1. Habif (2004) Clinical Dermatology, p. 446-50
    2. Janniger (2005) Am Fam Physician 72(5):833-8