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INTERTRIGO

The term “intertrigo” refers to the inflammation of the large skin folds. It develops due to friction of the skin folds and is aggravated by humidity, heat and lack of air circulation. Intertrigo is primarily found in skin folds beneath the breasts, in the groin, abdomen and around the anus. It may also present as diaper rash in infants.

Intertrigo usually clears up by itself if the affected areas are kept clean and dry. Sometimes, a secondary fungal or bacterial infection may develop at the site of intertrigo, for which medications may be necessary. People who are diabetic, obese, on bedrest or use medical devices like artificial limbs are more susceptible to develop intertrigo.

Sign and Symptoms

Intertrigo is a chronic inflammation of skin folds. It may cause the following signs and symptoms:

  • Red colored rash which may produce a discharge
  • Burning or stinging sensation in the affected skin
  • Foul odor of the affected skin
  • Cracked skin in the affected area

Worsening of these signs may indicate development of a secondary skin infection.

Causes

The factors that contribute to the development of intertrigo include- moisture, increased temperature, decreased air circulation and frictional rubbing of the skin folds. This condition may get complicated by various micro-organisms like yeast, dermatophyte fungi, bacteria and irritant chemicals.

Risk Factors

The following conditions may increase an individual’s susceptibility to develop intertrigo:

  • Diabetes
  • Obesity
  • Use of artificial limb
  • Exposure to humidity and heat
  • Excessive sweating
  • Poor hygiene
  • Malnutrition
  • Suppressed immune system
  • Incontinence

Specific skin disease like psoriasis may also cause intertrigo. In infants, chubby skin folds, short neck, and flexed postures increase the risk for intertrigo.

Complications

Intertrigo may often lead to secondary infections such as:

  • Fungal infection: This is more common in patients with impaired immune function, diabetes, rheumatoid arthritis and with long-term steroid use.
  • Bacterial infection: This infection may cause pruritus, abscess, erysipelas, cellulitis or osteomyelitis.

Diagnosis

The diagnosis of intertrigo is usually done clinically based on the findings of skin examination. The following tests may be useful to detect secondary infections:

  • Potassium hydroxide test: This test helps in detecting fungal infection. The physician removes a skin sample from the affected area treat it potassium hydroxide (KOH) solution. This solution destroys all non-fungus cells, and detects the presence of fungal cells.
  • Culture and sensitivity tests: This test is useful to identify the specific bacteria which has caused the infection. In this test, the affected skin sample is cultured in a nutrient medium which favors the growth of the bacteria. This test is also useful to determine the most effective anti-microbial treatment for the patient.

Treatment

  • No specific treatment is required for uncomplicated intertrigo. Keeping the affected area dry and exposed to air may be helpful in relieving inflammation. Creams containing zinc oxide may be useful to reduce skin irritation.
  • Intertrigo with secondary fungal infection can be treated with a combination of anti-fungals like clotrimazole and miconazole and low-potent topical steroids.
  • Immunosuppressants like tacrolimus and pimecrolimus are rarely prescribed to control the inflammation in intertrigo.

Home Care

The following home measures may be helpful in controlling the symptoms of intertrigo:

  • Using dry towels to wipe out sweat from the skin folds.
  • Wearing moisture wicking fabrics.
  • Wearing loose clothing.

Prevention

The following measures may be helpful to prevent intertrigo:

  • Frequent bathing especially in humid and warm climate.
  • Maintaining normal weight
  • Wearing loose-fitting clothes
  • Keeping the skin clean and dry every day
  • Changing diapers regularly in infants and using diaper rash cream
  • Wearing open-toed shoes.
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