What are the other Names for this Condition? (Also known as/Synonyms)

• Intertriginous Dermatitis

What is Intertrigo? (Definition/Background Information)

• Intertrigo is a common skin condition indicating an infection/inflammation that results in rashes in the flexural folds, such as in the armpits, beneath the breasts, in the groin region, behind the ears, and even between the digits. The condition may occur in children and adults of any age range
• Intertrigo may arise in infections, such as candidiasis and impetigo, and in inflammatory conditions, such as contact dermatitis and flexural psoriasis. The signs and symptoms of Intertrigo depend on the underlying cause. The presentations may be acute, chronic, or relapsing
• Managing the underlying infection/inflammation is important towards treating Intertrigo. The treatment measures may involve the use of topical applications, and oral medications, as necessary. The prognosis is dependent on the underlying cause and severity; it varies from one individual to another but is mostly good

Who gets Intertrigo? (Age and Sex Distribution)

• Intertrigo is observed in individuals of any age category, including infants, children, young and old adults
• Both males and females are affected
• Worldwide, individuals of all racial and ethnic background may be affected
• The condition is more commonly observed during hot-wet weather

What are the Risk Factors for Intertrigo? (Predisposing Factors)

The risk factors for Intertrigo may include:

• Individuals who are obese/overweight
• Genetic susceptibility
• Excess sweating
• Smoking and alcoholism
• Poorly-controlled diabetes
• Tight-fitting footwear may result in toe-web Intertrigo
• Individuals with braces, prosthetics, or splints have a higher risk
• Body areas frequently exposed to body secretions such as feces, urine, sweat, or saliva can develop the condition
  • Infants may get them in the diaper area (napkin dermatitis)
  • Urinary incontinence
• Immunocompromised individuals have a higher risk for this skin condition
• Individuals who are immobile or bedridden
• Vitamin B6 deficiency

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Intertrigo? (Etiology)

Genetic and environmental factors are implicated in the development of Intertrigo. The condition may develop due to several infectious or inflammatory conditions. In most cases, a disease-causing infectious agent is not clearly noted.

Infections causing intertrigo include:

• Boils and folliculitis, caused by Staphylococcus aureus
• Erythrasma, caused by Corynebacterium minutissimum
• Impetigo, caused by Staphylococcus aureus and Streptococcus pyogenes
• Cutaneous candidiasis, caused by Candida albicans and other species of fungus
• Tinea infection, caused by Trichophyton rubrum and T. interdigitale

Skin inflammations causing an Intertrigo-like presentation include:

• Atopic dermatitis
• Flexural psoriasis
• Fox-Fordyce disease
• Granular parakeratosis
• Hailey-Hailey disease
• Hidradenitis suppurativa
• Irritant contact dermatitis and allergic contact dermatitis
• Seborrheic dermatitis
• Toe-web Intertrigo
• Histiocytosis X in infants and toddlers

Experts inform that multiple factors are at play since the condition develops at the flexures (skin folds), which include:

• Skin friction - skin rubbing on skin causing breakdown of skin layers
• Increased temperature between the skin folds (flexures)
• Sweaty skin and impediment in sweat evaporation
• Overgrowth of skin microbiome, which are the naturally-residing bacteria, yeast, and other microorganisms on skin
• Irritant or contact dermatitis to agents in clothing, or medications used in an effort to improve Intertrigo

In general, Intertrigo is a non-contagious skin condition that cannot be spread from one individual to another. However, the infections that sometimes cause Intertrigo may be contagious.

What are the Signs and Symptoms of Intertrigo?

The signs and symptoms of Intertrigo may vary from one individual to another, depending on the severity and nature of the underlying inflammatory or infectious cause. The underlying cause may dictate what location of the body is affected and the characteristic presentations.

• Intertrigo caused by skin infections are observed on only one side of the body (unilateral) with asymmetric skin presentations
• Intertrigo caused by skin inflammations are typically noted on both sides of the body (bilateral, such as both armpits or elbows being involved) and are usually symmetric

Intertrigo can be acute, chronic (if present for more than 6 weeks), or recurrent and relapsing. The signs and symptoms may generally include:

• The skin on the flexural folds becomes red and swollen
• There is discomfort, pain, and sometimes bleeding
• Discharge with a foul odor may be noted
• The area of involvement is usually moist leading to maceration, which causes the skin to break and fissure and peel
• The condition may affect the armpits, beneath the breasts, the neck folds, abdominal folds, in the groin region, the buttocks, behind the ears, and even the spaces between the digits or buttocks
• Usually, more than a single body site may be involved

Additionally, other presentations of the underlying causative condition may be noted.

How is Intertrigo Diagnosed?

A diagnosis of Intertrigo may involve the following:

• Physical examination and a complete medical history; a dermatologist will visually examine the lesions to help in the diagnosis
• Blood tests, analysis of pus, culture of the fluid being drained (for causative pathogen), as needed
• Dermoscopy: Dermoscopy is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Skin biopsy: A skin tissue biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Note:

• A skin biopsy may be performed if Intertrigo does not respond well to treatment
• A differential diagnosis to exclude other similar skin conditions is important

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Intertrigo?

Intertrigo can cause the following complications:

• Emotional and psychological stress
• Cosmetic issues
• Secondary bacterial and fungal skin infections
• Scarring of the affected region; permanent scarring
• The condition may “come and go” several times - recurrences and relapses
• Treatment side effects

How is Intertrigo Treated?

The treatment of Intertrigo depends on the underlying cause and type of infection/inflammation. It may involve the following:

• Use of topical applications:
  • Topical and oral antibiotic creams for bacterial infections
  • Antifungal creams for fungal infections
  • Steroidal lotions and ointments for inflammatory conditions
  • Clear Castellani’s paint, an old topical treatment
• Phototherapy
• Minor surgery to drain pus from the lesions, if necessary

Self-care (home) remedies may include:

• Wash the affected area with mild soap
• Wash hands before applying topical applications
• Keep nails trimmed; do not pick at the lesions
• Keep the affected skin region clean and dry

How can Intertrigo be Prevented?

The preventative measures for Intertrigo are dependent upon the underlying inflammatory or infectious cause. In some cases, the condition may not be preventable. However, one’s risk for the same may be lowered through:

• Keeping skin cool and dry
• Avoiding tight clothes and shoes
• Avoiding synthetic (such as nylon) clothes, instead the use of cotton is recommended
• If obese or overweight, consider losing weight
• Use hair dryer on no heat or low heat setting after showering/bathing to keep skin dry
• If the condition develops from excess sweating, then showering and ensuring complete drying of skin, especially the flexural folds is beneficial. Also, one may use anti-perspirants, if necessary
• Minimize wearing of helmets, caps, and hats

What is the Prognosis of Intertrigo? (Outcomes/Resolutions)

• The prognosis of Intertrigo depends on the severity of the underlying inflammatory or infectious condition
• In many cases, with adequate treatment, the prognosis is good. However, the condition may recur

Additional and Relevant Useful Information for Intertrigo:

Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition. Care must be taken avoid strong soaps and chemicals that could potentially worsen the condition.