Intertrigo

Symptoms

Intertrigo (Latin for “rubbed sore”) is a common inflammatory skin condition that occurs on opposite skin surfaces in skin folds. It is initially manifested by a mild to severe redness that is approximately mirror image on both sides of the skin fold. It is often accompanied by itching, rash, burning sensation and pain. Papules and pustules on the marginal area, so-called satellite papules, indicate a secondary fungal infection with Candida. In the further course, erosions, exudations, rhagades, maceration and crusting may occur. Possible locations include the axillae, genital area, groin, anal groove, olecranon, belly button, abdominal folds, area under the abdomen, interdigital spaces, eyelids, chin, neck, area under the breasts and behind the ears. The pre-damaged skin, the warm and humid environment is an excellent breeding ground for microorganisms and favors secondary infection with fungi (Candida, dermatophytes), bacteria (streptococci (GABHS), staphylococci, Pseudomonas, Proteus) and at most with viruses. The most common pathogen is considered to be the yeast fungus . The symptoms of diaper dermatitis overlap with those of intertrigo (see there).

Causes

The main causes are considered to be, first, friction of skin surfaces against each other, accumulated moisture and heat; this damages the skin barrier. Second, superinfection with microorganisms. Risk factors include:

  • Overweight and obesity
  • Exercise, such as cycling or hiking.
  • Lack of exercise, for example, due to office work, in the elderly, bedriddenness.
  • Anatomical features, prostheses
  • Tight-fitting clothing, synthetic materials such as nylon
  • Diabetes mellitus
  • Incontinence, wearing incontinence pants
  • Sweating, vaginal discharge
  • Poor general and personal hygiene, e.g. urine in the groin.
  • Warm ambient temperature, warm season
  • Tight footwear
  • Young age (infants): short neck, stooped posture and rounded body predispose to skin wrinkles

If the risk factors can not be avoided or eliminated, intertrigo may recur.

Diagnosis

The diagnosis is made in medical or dermatological treatment based on the clinical picture and additional examinations, for example, with a pathogen detection. The rash may provide an indication of possible superinfections. Blisters are more likely to be a sign of a bacterial infection, scattered papules and pustules around the edges a sign of a Candida infection (satellite papules). Clearly demarcated, strongly reddened and malodorous rashes without satellite papules indicate infection with streptococci. Pseudomonas forms water-soluble pigments that result in a blue-green coloration.

Nonpharmacologic treatment

Recommended preventive and nonpharmacologic treatments include the following:

  • Keep appropriate areas dry and dry well after showering or bathing.
  • Avoid moisture, heat and friction if possible.
  • Avoid tight-fitting and synthetic clothing (eg nylon) and instead wear natural and breathable clothing (eg cotton).
  • To dry out, place a gauze or compress between the two surfaces of the skin and change regularly.
  • Good body hygiene.
  • Do not scratch, see also under the article itching.

Drug treatment

Skin care products:

Zinc oxide:

  • Zinc oxide is found in creams and ointments and has drying, astringent, skin-protective, wound-healing and mild antiseptic properties.

Topical glucocorticoids:

  • Glucocorticoids are anti-inflammatory and can be applied to treat the inflammatory processes. In self-medication, the weakly effective hydrocortisone is available, on medical prescription, more potent ones are also used.

Antifungals:

Antibiotics:

Other medicines: