Intertrigo is an inflammation, or rash, caused by yeast, fungus or a bacterium that typically forms in warm, moist areas of the body, usually the skin folds. People who are overweight and have diabetes most commonly contract intertrigo.

Causes

Intertrigo typically occurs due to the chaffing of moist, warm skin. It presents in the following cases:

• People who are diabetic and obese
• People who wear splints (a type of rigid support to maintain the body in position), braces, and artificial limbs
• People who lead a sedentary lifestyle
• Infants’ buttocks skin folds are vulnerable due to diaper use

 
Body folds are prone to infections because they provide the following optimum conditions:

• High skin temperature
• Moisture due to water loss and sweat not evaporating in these regions
• Chafing due to friction caused by rubbing together of two adjacent skins

Bacteria and yeast that are normally present on skin multiply rapidly in such conditions and cause damage to the skin.

The good news is that intertrigo is not contagious and it is relatively easy to identify. Intertrigo most often appears in the following areas:

• Neck creases
• Inner thighs
• Genitalia
• Between the toes and fingers
• Under the armpits
• Behind the ears
• On the underside of the belly
• On skin between the buttocks
• Under the breasts

Reddish-brown rashes, usually within the moist skin folds, indicate intertrigo. The rashes may be in the form of blisters and scales and the patient may complain of burning and itching at the rash site. In severe cases, foul odor, cracks, and bleeding may present in the infected region. The condition worsens when the patient sweats and these rashes often do spread to other regions.

A dermatologist performs the tests to determine a diagnosis of intertrigo because their specialized training is needed to look for the following conditions that may cause intertrigo:

• Inverse psoriasis – a tender red rash that only presents itself in the curved or folded areas of the body
• Hailey-Hailey – a rare hereditary blistering of skin
• Pemphigus – a skin disease with a specific, continuous blister formation
• Glucagonoma – a tumor on the skin that secretes the hormone glucagon

Typically, a dermatologist can identify an intertrigo just by looking at it. However, sometimes further examination aimed at finding the cause of intertrigo is performed to confirm the diagnosis and clarify the best course of treatment. For example, a swab is taken of the infection for both a culture and microscopic study to investigate for a bacterial infection. Close observation of the infected skin using a Wood’s lamp, a lamp that uses ultraviolet light to examine the skin, may also be performed in order to further rule out a bacterial infection.

A skin scrapping, or a KOH test, is often performed in order to rule out a fungal infection. A biopsy is usually not required but in conditions where the skin is unusually abnormal or fails to respond to other attempted treatment, a biopsy may be taken to determine the exact cause of the infection.

The cause of rash and the type of microorganism present in the rash determine the correct course of treatment for intertrigo. First of all, a gentle antiperspirant may be used to reduce sweat which helps in all types of infections.

If a bacterial infection is identified, then topical antibiotics like fusidic acid cream, mupirocin ointment, or oral antibiotics like flucloxacilin and erythromycin may be prescribed to the patient.

Topical antifungals like clotrimazole and terbinafine creams or oral medication like itraconazole or terbinafine are prescribed in the cases of a fungal or yeast infection.

Inflammation of the skin is often treated with mild steroid creams such as hydrocortisone. In the instances of oozing sores, they may be dried using medication such as Burow's solution, a pharmacological preparation made of aluminum acetate dissolved in water. Moist compresses using Burow's solution are recommended followed by air drying to control any oozing around the site of the rash.

There is very little that a person can do to avoid intertrigo. However, the following measures can minimize the occurrence of intertrigo:

• Keep the skin dry and cool
• Thoroughly dry skin fold regions before putting on clothes
• Wear loose fitting, comfortable, breathable, cotton clothing
• Avoid tight fitting jeans, shoes, and underwear
• Embark on a weight loss plan to minimize folds in the skin
• Use an antiperspirant especially if excess sweating occurs
• Wash with antibacterial soaps
• Apply talcum powder between skin folds to help to reduce friction
• Take showers and dry off completely after any rigorous physical activity or exercise

Skin rashes are a very common condition; most people get a rash at some point in their lives. Most of the time, skin rashes are due to trapped moisture in regions of the body that do not receive enough air exposure. Taking a few of the above-mentioned steps might help people prevent infections rather than trying to chase down a solution after the fact.