Intertrigo, or the inflammation of the body folds, is a common disturbing skin condition in most obese and diabetic patients. Treatment involves pinpointing the exact cause, controlling the predisposing factors and treatment of specific causes. Some authors include any skin conditions affecting the skin folds as intertrigo.
What is the Cause of Intertrigo?
Intertrigo can be caused by mechanical, chemical or biological agents. Mechanical causes include exposure to excess heat, retention of moisture after bath, swimming or sweat after exercise and friction between skin surfaces due to obesity, cycling or exercise. Biological causes of intertrigo include either bacterial or yeast infection superadded to the macerated skin of the folds. Streptococcus pyogens is the most common germ involved in bacterial intertrigo. Staphylococcus aureus is also found in some cases. Chemical irritation to detergents and certain topical applications like potent steroids can damage the intertriginous skin and predispose to inflammation.
What are the Types of Intertrigo?
Intertrigo can be classified according to the causes and the sites of involvement. Depending upon the causes, as discussed above, intertrigo can be classified as mechanical, chemical, bacterial and candidal intertrigo. Depending upon the sites involved, intertrigo could be retro auricular, sub auricular, axillary, intermammary, submammary, periumbilical, inguinal, genito-crural, vulvar, intergluteal, perianal, interdigital, toe space etc. Many diseases, including eczema can cause intertrigo in the perianal region.
What are the Signs and Symptoms of Intertrigo?
The skin fold turning red and slightly macerated is the first sign of intertrigo. Separating the folds reveals the maceration in the center with the red surrounding area. Itching, soreness, burning, oozing and an offensive odor are the common presenting symptoms of intertrigo. Presence of certain putrefying bacteria like the coryneform brevibacteria is the cause for the malodor.
Uncontrolled intertrigo causes complete denuding of the skin surface resulting in painful fissures.
Intense itching (pruritus ani) and painful fissures are more common in perianal or intergluteal intertrigo.
What are the Predisposing Factors in Intertrigo?
Increased mechanical friction between the skin folds is the commonest cause of intertrigo in the obese. Intertrigo is also common in conditions with lowered immunity like diabetes, cancer and usage of immunosuppressant medications like the steroids.
Thick apposing skin surfaces kept in the same position for a long time without any movement is the cause for intertrigo in most bonny infants.
How to Find the Real Cause of the Intertrigo?
In most cases, experienced dermatologists can diagnose the cause of the intertrigo from the clinical appearance itself. Intertrigo caused by bacteria gives the classical appearance with central area of smegma-like maceration and surrounding erythematous (red) inflamed area and the offensive odor. Yeast intertrigo shows small satellite rashes in the surrounding area. Compared to the bacterial intertrigo, the odor in candidal intertrigo is less offensive.
Tinea cruris, fungal infection of the groin, is the main condition to be differentiated from intertrigo in this region. A sharp, raised margin with central clearance is typical of the ring worm patches.
A simple scrapping of the macerated smegma onto a slide followed by examination under microscope after dissolving in a potassium hydroxide solution or staining with gram’s stain will differentiate between the bacteria and the yeast in doubtful cases.
Other conditions that have to be differentiated from intertrigo include seborrheic dermatitis, flexural psoriasis, Hailey Hailey disease and flexural Darier’s disease.
How to Treat Intertrigo?
Treatment of intertrigo includes general measures and specific measures. General measures include weight reduction, control of moisture retention in folds and taking care of the predisposing diseases like diabetes. An antifungal powder dusted over after bath usually keeps yeast intertrigo from recurring in the obese and the diabetics.
Specific treatment includes the treatment with topical and systemic antibacterials and anti-yeast preparations, as the case may be.
References:
- Mycology, in Rook’s Textbook of Dermatology, 7th Edition, 2004
- Valia RG, AR Valia. Eczema, in IADVL Textbook of Dermatology, 3rd Ed, 2008
Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or suite101 will not be responsible for any consequences. The images provided are for illustration purpose only.
Hanish Babu - Dr.Hanish Babu, MD is a dermatologist and a feature writer on Suite101.com with more than 200 articles related to skin diseases on the ...
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