Intertrigo

  • Medical Author:
    Gary W. Cole, MD, FAAD

    Dr. Cole is board certified in dermatology. He obtained his BA degree in bacteriology, his MA degree in microbiology, and his MD at the University of California, Los Angeles. He trained in dermatology at the University of Oregon, where he completed his residency.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

Intertrigo facts

  • Intertrigo is a rash (dermatitis) that affects skin folds.
  • Intertrigo is caused when frictional forces, enhanced by heat and moisture, produce skin irritation.
  • Risk factors for intertrigo include obesity, heat, and humidity.
  • Intertrigo patients complain of redness, burning, and itching in the skin folds, most commonly in the groin, under the breast, and in the armpits.
  • Occasionally, long-standing intertriginous dermatitis may produce a musty smell.
  • Intertrigo is diagnosed by visual inspection after eliminating infectious causes.
  • Treatment involves the reduction of frictional forces, humidity, and heat in the skin folds.
  • Intertriginous dermatitis can be infected by bacteria and fungi. Eruptions in the skin folds can occur in a number of other dermatological conditions aside from intertrigo.
  • Intertrigo can be prevented by losing weight and applying lubricating topical preparations prior to athletic endeavors.
  • The prognosis of intertrigo is excellent.

What is intertrigo?

Intertrigo is a very common inflammation affecting skin-on-skin contact, such as the groin, armpits, under the breasts (inframammary skin), and skin folds on the anterior torso (panniculus). These areas of skin that touch each other are referred to as the intertriginous zones. In obese individuals, skin folds may occur in a variety of other areas and so can be affected by intertrigo.

What causes intertrigo?

A combination of frictional rubbing, increased temperature, and moisture cause an irritant dermatitis known as simple intertrigo. Intertrigo can be complicated by various microorganisms, including yeasts (candidal intertrigo), dermatophytic fungal intertrigo, Gram-positive bacteria (erythrasma), as well as allergic and irritant reactions to various medications and chemicals. There are also some uncommon exotic dermatologic diseases that have a predilection to appear in the intertriginous zones. The differential diagnosis (other conditions that resemble intertrigo) include familial pemphigus, hidradenitis suppurativa, inverse psoriasis, staphylococcal or streptococcal impetigo, and seborrheic dermatitis. Group A strep can cause a rare form of streptococcal skin infection that produces a severe form of intertrigo affecting the neck creases, groin, perianal tissue, and toe webs of infants. Aggressive treatment is appropriate for these conditions.

SLIDESHOW

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Intertrigo Symptom

Itching

Itch is an irritation in the skin that elicits an urge to scratch. Itches are a problem that everyone experiences, and the symptom can be localized (limited to one area of the body) or generalized (occurring all over the body or in several different areas). Sometimes, depending upon the underlying cause, itching may be worse at night. In medical terminology, itching is known as pruritus.

Generalized itch that occurs all over the body is often more difficult to treat than localized itch. Itches can also occur with or without skin lesions (bumps, blisters, rash, redness, or abnormalities that can be seen on the skin). An itch that is accompanied by a visible skin abnormality should be evaluated by a physician and, in some cases, by a dermatologist since the problem is likely to be a condition that requires specialized medical treatment (for example, eczema, scabies, etc.).

What are risk factors for intertrigo?

Environmental factors play a major role in exacerbations of intertrigo. They include increases in temperature and humidity encountered most frequently during the summer months.

Activities such as bicycle riding or running, which produce repetitive movements resulting in frictional forces which may injure the skin. Men are predisposed to intertrigo of the groin because of the occlusion produced by the male external genitalia. The presence of large folds of skin, such as those that result from obesity, also enhances the likelihood of intertrigo.

What are intertrigo symptoms and signs?

Symptoms of intertrigo include itching and burning in the intertriginous zones. Occasionally, long-standing intertrigo may produce a musty smell. With intertrigo, these areas become inflamed and appear red-brown and sometimes scaly.

What types of physicians diagnose and treat intertrigo?

Intertrigo can be diagnosed by most doctors purely on the basis of its appearance -- a red rash affecting one or more intertriginous areas. If the condition does not respond to conventional treatments, then a referral should be made to a dermatologist.

What are intertrigo home remedies and treatments?

Treatment of uncomplicated intertrigo primarily involves changing those environmental factors that have predisposed the patient to the condition. Areas of involvement are covered with a mild topical steroid like 1% hydrocortisone cream, which is available without a prescription (over the counter, or OTC), and then covered with zinc oxide paste or ointment (Desitin).

What are complications of intertrigo?

Intertrigo may be complicated by a variety of infectious microorganisms that must be eliminated before the condition is likely to improve. Since fungal infections are very common in the intertriginous zones, it is important to perform appropriate tests (such as microscopically analyzing small scrapings of affected skin) to exclude this problem. Most dermatologists and some primary care physicians are able to perform potassium hydroxide mounts of scale obtained from the irritated skin right in the office and visualize the fungus under the microscope. There are a variety of other skin diseases that may present a picture similar to intertrigo but are treated quite differently. If the condition does not respond to the simple treatment methods listed above, further diagnostic procedures may have to be done to elucidate the true diagnosis. It is important to make the correct diagnosis in order to select the appropriate treatment. For example, if a yeast or dermatophyte fungus is present, then appropriate topical antifungal therapy is indicated. On the other hand, if a bacteria is involved, then antibiotics are appropriate either topically or orally.

What is the prognosis of intertrigo?

If the patient is willing to change certain habits that may predispose to intertrigo the prognosis is quite good. It almost always resolves rapidly.

Is it possible to prevent intertrigo?

It's possible to prevent simple intertrigo by liberally applying a lubricating ointment like petrolatum directly into the intertriginous skin fold predisposed to irritation prior to any physical activity. Carefully drying the affected area after bathing or showering is also helpful. In obese individuals with a large abdominal skin folds (panniculus), weight reduction and occasionally excisional surgery may diminish the folds, preventing intertrigo.

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Intertrigo Browse through our medical image collection to see pictures of the most common, and uncommon, skin conditions See Images

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Medically Reviewed on 8/9/2019
References
Janniger, Camila K., Schwartz, Robert A., Szepietowski, Jacek C., and Reich, Adam. "Intertrigo and Common Secondary Skin Infections." American Family Physician 72.5 Sept. 1, 2005: 833-838.

Kalra, Monica G., Kim E. Higgins, and Bruce S. Kinney. "Intertrigo and Secondary Skin Infections." American Family Physician 89.7 Apr. 1, 2014: 569-573.
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