What is intertrigo?
Intertrigo describes a rash in the flexures or body folds, such as behind the ears, in the folds of the neck, under the arms (axillae), under a protruding abdomen, in the groin, between the buttocks, in the finger webs or toe spaces.
Although intertrigo may affect one skin fold, it is common for it to involve multiple sites.
Who gets intertrigo?
Intertrigo can affect males and females of any age. It is particularly common in people that are overweight or obese (see metabolic syndrome). Other contributing factors are:
- Genetic tendency to skin disease
- Hyperhidrosis (excessive sweating)
What are the clinical features of intertrigo?
Intertrigo can be acute (recent onset), relapsing (recurrent), or chronic (present for more than 6 weeks). The exact appearance and behaviour depends on the underlying cause or causes.
The skin affected by intertrigo is inflamed, ie reddened and uncomfortable. It may become moist and macerated, leading to fissuring (cracks) and peeling.
What is the cause of intertrigo?
Intertrigo is due to genetic and environmental factors.
- Flexural skin has relatively high surface temperature
- Moisture from insensible water loss and sweating cannot evaporate due to occlusion.
- Friction from movement of adjacent skin results in chafing.
The microorganisms that are normally resident on flexural skin, the microbiome, include corynebacteria, other bacteria and yeasts. These multiply in warm moist environments and may become pathogenic, ie cause disease.
We can classify intertrigo into infectious and inflammatory origin but there is often overlap. Infections tend to be unilateral and asymmetrical. Inflammatory disorders tend to be symmetrical affecting armpits, groins, under the breasts and the abdominal folds, except atopic dermatitis, which more often arises on the neck, and in elbow and knee creases.
Tinea cruris (groin)
Athletes foot (between toes)
|Contact irritant dermatitis||
|Contact allergic dermatitis||
What investigations should be done?
Investigations may be necessary to determine the cause of intertrigo.
- A swab for microscopy and culture of bacteria (microbiology)
- A scraping for microscopy and culture of fungi (mycology)
- A skin biopsy may be performed for histopathology if the skin condition is unusual or fails to respond to treatment.
What is the treatment for intertrigo?
Treatment depends on the underlying cause, if identified, and on which micro-organisms are present in the rash. Combinations are common.
- Sweating may be reduced with a gentle antiperspirant.
- Bacteria may be treated with topical antibiotics such as fusidic acid cream, mupirocin ointment, or oral antibiotics such as flucloxacillin and erythromycin.
- Yeasts and fungi may be treated with topical antifungals such as clotrimazole and terbinafine cream or oral antifungal agents such as itraconazole or terbinafine.
- Inflammatory skin diseases are often treated with low potency topical steroid creams such as hydrocortisone. More potent steroids are usually avoided in the flexures because they may cause skin thinning resulting in stretch marks (striae) and even ulcers. Calcineurin inhibitors such as tacrolimus ointment or pimecrolimus cream may also prove effective.