|Treatment action||Topical/behavioral||Oral meds||Testing/Notes|
|Comfort measures, general care||It is imperative to address the precipitating factors and, at all costs, to prevent the skin-on-skin contact that causes this condition. Short term comfort: Sitz bath, gentle cleansing with gentle drying of skin surfaces, topical petrolatum or drying agents, avoidance of irritants or tight clothing or any chafing, application of cool gel packs.
May use T-shirt fabric or other soft, cotton fabric between skin folds to prevent chafing or maceration.
Long term comfort: Loose weight, improve incontinence and its management.
|Most intertrigo is fungal in origin, the most common yeast being C. Albicans. It is commonly diagnosed clinically. In the genital area, it is found in the crural folds. (Also under breasts or under panus).
Skin scrapings mixed with KOH can reveal the budding spores and/or pseudohyphae of yeast. Yeast culture can also be done.
If the skin is badly macerated, obtain a bacterial culture as well as a fungal culture.
Intertrigo is more likely with increased moisture between skin surfaces, increased friction, or lowered immune response.
Link to Intertrigo in Atlas.
|Anti-fungal treatment||Clotrimazole 2% cream applied twice a day until symptoms resolve
Miconazole 2% cream applied twice a day until symptoms resolve
(may also use ketoconazole, econazole, and sertaconazole. May also use topical terbinafine or naftifine; these options are rarely needed.)
Ciclopirox 0.77% cream applied twice a day until symptoms resolve.
|Fluconazole 50-100 mg orally daily or 150 mg orally weekly for 2-6 weeks or until symptoms are gone
Itraconazole 200 mg orally twice daily for 2-6 weeks or until symptoms are gone
|Topical antifungals are the mainstays of treatment, along with preventing skin surfaces from touching. Ciclopirox is an anti-fungal which also has anti-bacterial activity against gram-positive and gram-negative bacteria.Use oral meds only if the patient has failed topical treatment or has a very severe case.
Do NOT use oral ketoconazole, which can cause liver toxicity.
Do not use oral terbinafine.
Drug interactions with oral antifungals are common; check before prescribing.
Azole resistance has begun to emerge. Use as little oral anti-fungal medication as possible.
|Drying agents||Miconazole, nystatin, undecylenic acid, tolnaftate and 12% benzoic acid come as powders that can be used twice weekly as preventives.
Domeboro’s solution applied topically twice weekly
Zeasorb powder (miconazole) applied twice daily or twice weekly
Corn starch applied topically any time.
|Do not use drying agents concomitantly with topical ointments. Best used after skin has cleared up as a preventive action.|
|Reduction of itching or pain||Topical xylocaine 5%, applied as needed, usually 4-6 times a day (no more than 15 grams a day)||Hydroxyzine 10 to 25 mg orally 1-2 hrs prior to bedtime; (may start at 10 mg and increase nightly to a maximum of 75 mg) (to prevent scratching)OR
Benadryl 25-50 mg orally 1-2 hrs prior to bedtime, stopping meds as symptoms subdue.
|These are rarely needed.|
|Anti-inflammatory action||1% to 2.5% hydrocortisone ointment applied once or twice daily for mild inflammation.||Steroid creams or ointments are rarely needed. Avoid moderate and high potency steroids with this condition.
A low potency hydrocortisone may help with pain, itching, and burning.
|Antibiotics for superimposed infection||Mupirocin ointment (Bactroban) applied topically three times a day until symptoms improved.||Erythromycin 250 mg orally four times a day for 7 days.|
Updated 7/11/14 Link to Intertrigo in Atlas.