Intertrigo

What is Intertrigo?

Intertrigo is a skin condition that usually affects the areas of your body where skin rubs against skin, like under the arms or under the breasts. It’s caused by a combination of warm temperatures, excessive moisture, and poor air flow. This leads to skin irritation known as inflammation. The term ‘intertrigo’ comes from two Latin words “inter” and “terere” which together mean “rub between.”

This skin condition often becomes infected, primarily with a type of yeast known as Candida. However, other bacteria or viruses can also contribute to the infection. Although intertrigo can occur in people of all ages, it’s mainly diagnosed by examining the signs visible on the skin. Commonly affected areas include the armpits, under the breasts, the folds of the belly, and the area around the genitals and anus. These often appear as red patches of various intensity. As the condition worsens, secondary lesions or sores can develop.

What Causes Intertrigo?

Intertrigo, a skin condition that occurs in areas of the body where skin rubs against skin, is often caused by two main factors: mechanical issues and secondary infections. Let’s break this down a bit.

Firstly, the condition is often caused by factors like heat and moisture that soften the skin, making it easier to break down. The constant rubbing of skin against skin can irritate the skin, and sometimes even create small, painful breaks.

Secondly, the moisture that builds up in the folds of the skin creates the perfect environment for secondary infections to grow. Secondary infections are new infections that occur in a person who is already sick or recovering from another infection.

Candida, a type of fungus, thrives in warm, wet environments and is often responsible for these secondary infections in intertrigo cases. However, it’s not only Candida that can cause these infections. Sometimes gram-positive and gram-negative bacteria, as well as other fungi and viruses, can also be responsible.

Additionally, people with diabetes may be more likely to get intertrigo. This is because they tend to have higher pH levels in their skin folds, which makes it easier for the condition to develop.

It’s important to remember that all these different factors can contribute to intertrigo, so it might be different for each person.

Risk Factors and Frequency for Intertrigo

Intertrigo is an inflammatory skin condition that affects people of all age groups, from infants to the elderly. It often appears in babies as a kind of diaper rash. There are several factors that can increase a person’s risk of developing intertrigo. These include having a weak immune system, issues with mobility, or inability to control bowel and urine movements. Conditions such as obesity and diabetes also make intertrigo more likely. This condition is also more common in hot and humid climates. Importantly, anyone, regardless of gender or ethnicity, can be affected by intertrigo.

• Intertrigo can affect all age groups.
• In babies, it often appears as a type of diaper rash.
• Risk factors include a weak immune system, mobility issues, and incontinence.
• Obesity and diabetes can increase the risk of intertrigo.
• The condition is more common in hot, humid climates.
• Both genders and all ethnicities can be affected.

Signs and Symptoms of Intertrigo

Intertrigo is a skin condition that usually develops slowly over time, causing itching, burning, and pain in the folds or creases of the skin. If the symptoms suddenly become much worse, there might be an additional infection with a fungus or bacteria. This condition is often caused by activities that involve friction between skin surfaces. It’s more common in hot, humid weather and can also be brought on by heavy sweating, especially during strenuous exercise.

• Itchy, burning skin
• Pain in skin folds or creases
• Sudden worsening of symptoms could indicate an additional infection
• Caused by activities involving skin-to-skin friction
• More common in hot, humid weather
• Heavy sweating can trigger condition

Conditions such as obesity and diabetes, or symptoms such as incontinence or discharge, can increase the chances of developing intertrigo. On physical checks, doctors find this condition most frequently in overweight patients, but it can affect anyone. The increased skin folds in obese patients provide an environment where the disease can thrive.

Doctors can identify intertrigo by spotting a red patch on both sides of a skin fold. The inflammation’s severity depends on the infection’s location and how long it’s been present. Eventually, the red patch can develop into sores, cracks, or blisters. If a blister, crust, or pimple-like bumps appear, there might be a secondary infection. Different appearances of the infected area might indicate different types of infections—for example, a bluish-green color could mean it’s a Pseudomonas infection.

Testing for Intertrigo

If your doctor is uncertain about what’s causing your health issue, they might need to perform further tests to identify the cause and decide the best treatment approach. One way of doing this is by taking a sample from the affected area (a process known as ‘culturing’) if they think a bacterial infection might be responsible for your symptoms.

In other cases, they may suspect that a fungus is the cause of your symptoms. In such situations, your doctor can take a small scraping of skin from around the area where the issue is most active. This sample will then be treated with a solution made of potassium hydroxide (KOH). When this sample is viewed under a microscope, the presence of structures called ‘hyphae’ or budding yeast cells can indicate a fungal infection.

If your symptoms are not typical, or if treatments haven’t worked as expected, your doctor might perform a biopsy. This involves taking a small sample of tissue for further examination. A special light called a Wood lamp can help identify certain types of infections like Pseudomonas bacteria or Erythrasma (an infection caused by a bacterium called Corynebacterium minutissimum).

If the doctor suspects that diabetes might be impacting your health, they may test your blood sugar level after you have fasted (not eaten anything). This test can be particularly important if you’ve been having trouble treating the current issue, or if it keeps coming back.

Treatment Options for Intertrigo

When treating intertrigo, which is a rash that usually appears between skin folds, it’s important to identify and address the underlying cause. For instance, if the rash is caused by an infection, the right antimicrobial medication can be administered.

For simpler cases of intertrigo, keeping the skin dry can be beneficial. This can involve using drying agents like antiperspirants, especially after activities that lead to excessive sweating. Towel-drying properly after a bath or shower can also help. A combination paste made of aluminum acetate solution, zinc oxide, and petrolatum can act as an effective antiperspirant that reduces skin irritation.

Wearing loose clothing and staying cool can help prevent the rash. Using absorbent powders or wet tea bags can also be effective. For babies, absorbent diapers can decrease moisture, and petrolatum ointment or cream can be used for diaper rash, if necessary.

If the rash is lightly infected with bacteria, topical treatments like mupirocin or bacitracin creams can be used. If an oral medication is needed, drugs effective against gram-positive bacteria, such as Staphylococcus or Streptococcus, like flucloxacillin or erythromycin might be prescribed.

If the rash is infected with yeast or fungi, topical clotrimazole, ketoconazole, and oxiconazole are effective treatments. Topical nystatin is especially effective for candidal intertrigo, a specific type of yeast infection. These topical treatments can be applied twice daily until the rash resolves. If these are resistant to the infection, oral versions of these medications might be used.

Low-dose steroids, such as hydrocortisone cream, can also be used for their anti-inflammatory properties, but aren’t always necessary. When they’re used, lower-strength steroids are usually preferred to prevent thinning of the skin, which is already thin in the areas typically affected by intertrigo.

What else can Intertrigo be?

When diagnosing intertrigo, a type of skin inflammation that occurs in the folds of the skin, doctors will first rule out a number of infections that could be causing the symptoms. These can be caused by a number of microorganisms, such as bacteria, viruses, yeast-like fungus (candida), or even certain types of mold (dermatophytes).

Once an infection has been ruled out, doctors will consider other conditions that could be causing the symptoms, including:

• Seborrheic dermatitis, a type of skin rash that mainly affects the scalp.
• Irritant or allergic contact dermatitis, which is caused by coming into contact with certain substances.
• Atopic dermatitis, also known as eczema.
• Inverse psoriasis, a type of psoriasis that affects the skin folds.
• Pemphigus, a rare skin disorder that causes blisters.
• Scabies, a skin infestation caused by a tiny mite.
• Metabolic derangements, various types of disorders that affect the body’s metabolic processes.
• Malignancies or cancer that affects the skin.

After considering these conditions, if none of them seem to be the cause, the doctor may diagnose the patient with intertrigo. This diagnosis is made based on the symptoms and findings from the physical examination.

What to expect with Intertrigo

Most people with intertrigo, a skin inflammation usually caused by friction in warm, moist areas, have a good chance of recovery. However, certain underlying problems can increase the risk for this condition. It’s important to manage these risks to prevent frequent outbreaks of intertrigo. Key risks include diabetes and obesity. If these are not well-controlled, the condition tends to come back quite often.

Possible Complications When Diagnosed with Intertrigo

The main complications related to intertrigo mainly involve secondary infections, which we’ve covered already. It’s crucial that a health professional inspect the rash to ensure it’s managed properly, which can prevent any potential infections. If the rash isn’t dealt with, it can progress into a bacterial skin infection – also called cellulitis.

The risk arises from hidden sores that can form in unsupervised patients or those who are overweight. These can lead to sepsis, a serious condition caused by the body’s response to an infection. Contact dermatitis – a type of skin irritation – may also happen as a result of products used to manage the rash. Additionally, extended use of steroidal medication can cause thinning and stretch marks on the skin in folds.

Possible Complications:

• Secondary infections
• Cellulitis if left untreated
• Sepsis from hidden sores
• Contact dermatitis from treatment used
• Atrophy and skin marks with prolonged steroid use

Preventing Intertrigo

Losing weight and maintaining a healthy weight, practicing good hygiene, managing blood sugar levels for those with diabetes, and taking steps to lessen the rubbing caused by skin-to-skin contact are topics that should be talked about with the patient and their loved ones. It’s important to understand that these actions can help improve health and prevent future complications.