Intertrigo, not a very commonly used term, but a very common condition that causes rash in the skin folds, where two skin rubs against each other. Intertrigo is actually an inflammation in warm moist areas of the body where two skins contact and rub against each other. Intertrigo is very common in people who are overweight and who have diabetes. An intertrigo is sometime referred to as bacterial, viral, or fungal infection that develops at the site of rashes and causes inflammation. The condition most often worsens by candidal (yeast) infection.
Causes
Intertrigo occurs commonly due to chaffing of moist, warm skin, especially in people who are diabetic and obese. It is commonly caused by yeast Candida albicans; fungi, and bacterial infections are also seen. People who have splints (a rigid support to maintain the body in position), braces, and artificial arms are commonly affected by intertrigo rashes. People who have excess amount of any body fluids, people who normally overdress and people who lead a sedentary mode of like are at high risk of getting intertrigo. In infants, it occurs in the skin fold of buttocks due to diaper use or being wet for a long time. The skin folds are prone to infections than any other part of the body because body folds have relatively high temperature and are moist due to water loss/sweat. Sweat does not evaporate easily in these regions. In addition, friction may be caused due to rubbing of two skins. Bacteria and yeast that normally are present on skin multiply in such favorable conditions and cause infection. Intertrigo is non-contagious, which means that it cannot be passed to another person by physical contact.
Identifying intertrigo
Intertrigo commonly occurs in areas like neck creases, thighs, intergluteal folds, between the toes, behind the knees, in front of the elbow, armpits, behind the ears, lower belly, skin between the buttocks, and underside of the breast. Intertrigo can be identified by the presence of red or reddish-brown rashes usually in regions of skin folds that are moist. The rashes may be in the form of blisters and scales. The person may complain of burning sensation in the spot and itching. In severe cases, foul odor, crack, and bleeding from the infected region may occur. The condition worsens by sweating. These rashes usually spreads to other regions too.
Diagnosis
Diagnosis of intertrigo is better done by a dermatologist than a normal physician, as many other conditions like – inverse psoriasis, Haily-Haily (rare hereditary blistering of skin), pemphigus (skin disease with continuous blister formation), and glucagonoma (glucagon-secreting tumor) may cause intertrigo. A dermatologist can identify an intertrigo just by looking at it. But further diagnosis is done, which is aimed at finding out the cause of intertrigo. A swab of the infection for culture and microscopic study of the micro-organism, usually bacteria is done. Skin scrapping and KOH examination may be done to rule out fungal infection. Close observation of the infected skin using a Wood’s lamp, which uses ultraviolet light may be done, to rule out bacterial infection. Biopsy is usually not required but in conditions where the skin is unusually abnormal or fails to respond to treatment, a biopsy may be taken to determine the exact cause.
Treatment
Treatment for intertrigo lies on the cause of rash and on the type of microorganism present in the rash. Sometime a combination of both may occur. A gentle antiperspirant may be used to reduce sweat. If bacterial infection is identified, then topical antibiotics like fusidic acid cream, mupirocin ointments or oral antibiotics like flucloxacilin and erythromycin may be prescribed. Topical antifungals like clotrimazole and terbinafine creams or oral medication like itraconazole or terbinafine is prescribed for fungal or yeast infection. Inflammation in the skin is often treated by mild steroid creams such as hydrocortisone. Oozing out may be controlled by moist compresses using Burows solution followed by air drying.
Prevention
There is little that a person can do to avoid intertrigo but taking certain measures can minimize the occurrence of intertrigo.
- Keep the skin dry and cool
- Dry the skin fold regions thoroughly before wearing clothes
- Wear loose fitting, comfortable cotton clothes
- Avoid tight fitting jeans, shoes, and underwear
- If obese, reducing weight might help
- If excess sweating occurs, use an antiperspirant
- Using antibacterial soaps can also help
- Applying talcum powder between folds of skin help to reduce friction
- Proper cleaning of the applied powder is very important
- Take a shower and dry completely after physical activity/exercise
Outlook
Skin rashes are very common condition; everybody would have got rashes at one point of time in their life. Mostly skin rashes are due to trapping up of moisture in regions that are hardly exposed to air. As said “Prevention is better than cure” it is always better to prevent such skin infection than juggling to cure it. A clean and dry skin is the sign of healthy skin.
