Overview

Intertrigo is a skin disorder that causes a rash, usually in skin folds such as armpits, groin, toe webs and under the breasts. These areas can get hot, sweaty and moist and the skin in the folds can become irritated and swollen due to friction. 

Anyone can get intertrigo but it is more common in older people and those with conditions such as diabetes or compromised immunity. Babies often get nappy rash which is a form of intertrigo. 

Intertrigo can often be treated at home by ensuring the affected areas are kept clean, dry and ventilated. 

In some instances, intertrigo can become infected by fungal organisms such as candida or bacteria such as Staphylococcus aureus. These infections will need to be treated by physical and pharmacological means to prevent the development of more severe illnesses, such as sepsis. 

Definition of intertrigo

Intertrigo, also known as intertriginous dermatitis, is one of four conditions that fall under the umbrella term of moisture-associated skin damage. It can affect individuals of all ages but is most common in older people and those with other illnesses that affect immunity. It is a common inflammatory skin disorder caused by skin-on-skin friction within skin folds, as a result of moisture becoming trapped due to poor air circulation.¹

Causes of intertrigo

There are some factors which can cause intertrigo or cause it to worsen:

Moisture and friction

Skin that is likely to get moist with sweat or lack of full drying after washing, such as under the breasts is more prone to intertrigo. These areas are also often more likely to experience friction. Incontinence and excessive sweating can also help cause the condition. 

Heat and lack of ventilation

Areas that get little ventilation and might get warm are more prone to intertrigo. This can be seen in cases of nappy rash, where the area is covered by a nappy which can be warm, unventilated and also often moist due to urine and faeces.

Microbial growth

Fungal and bacterial growth can occur in the physical conditions that allow intertrigo to develop and cause the condition to develop further. 

Symptoms of intertrigo

Early symptoms of intertrigo can include:

• A red or reddish-brown rash 
• Small bumps in an area where the skin rubs against itself such as under the breast, groin area or thighs
• Itching, stinging and burning in the affected area 
• Discomfort in the affected area 
• Pain in the affected area

Risk factors for intertrigo

Intertrigo is a superficial inflammatory skin condition of the skin's flexural surfaces, caused or made worse by warm temperatures, friction, moisture and poor ventilation. There are particular risk factors for developing intertrigo. These are:

Obesity

Intertrigo is strongly associated with obesity. People who are overweight usually have more pronounced skin folds and can suffer from increased sweating. It can also be more difficult for people with obesity to properly clean and care for their skin folds.

Diabetes

Diabetes, both Type 1 and Type 2, can cause high blood sugar which makes it more ideal for bacteria and fungi to grow and multiply. This makes the risk of developing intertrigo or other skin disorders higher. 

Reduced immunity

The immune system of the body fights infection. Some illnesses can weaken that immunity such as: 

• Human immunodeficiency virus (HIV) and AIDS
• Cancer
• Pregnancy
• Alcohol use disorder
• Liver disease
• Kidney disease  
• Organ or tissue transplant
• Lupus 
• Rheumatoid arthritis  
• Multiple myeloma 

Certain drugs and therapies can also weaken the immune system, such as:

• Immunosuppressants  
• Corticosteroid medications for conditions such as lupus, inflammatory bowel disease, arthritis or asthma
• Tumor necrosis factor inhibitors

Age and lifestyle factors

Older age is associated with an increased incidence of intertrigo as is reduced mobility.² 

Poor hygiene

Poor hygiene such as not showering regularly, especially after exercise also increases the risk of developing intertrigo.

Clothing

Tight, abrasive underclothing or dirty or sweaty clothing may also be a factor in the development of intertrigo. 

Complications of untreated intertrigo

If intertrigo is not treated in its early phase, the following symptoms can develop:

• The raw sensation of the skin
• Cracks in the affected skin
• Bleeding or oozing from the affected skin
• Crusted or scaly skin in the affected area
• Infection
• Painful lesions or ulcers
• Sepsis

Infection in intertrigo

Infection is a more serious result of inadequate treatment for intertrigo that could potentially lead to sepsis and other complications. Infection in intertrigo can develop due to several sources: 

• Bacterial infections such as Staphylococcus aureus
• Fungal infections such as candidiasis³

Signs of infection

Symptoms of intertrigo with an infection can include:

• A foul smell in the affected area
• Redness and heat in the affected areas
• Bumps on the affected skin that contain pus
• Raised, tender bumps on the affected skin
• Pus from the affected area
• Fever 

Prevention and treatment of intertrigo and infection

Prevention strategies

• Keep skin folds clean and dry. Ensure that the affected areas are regularly washed and dried thoroughly
• Avoid scented powders and creams
• Wear loose clothing and change regularly
• Maintain a healthy weight and lifestyle

Nappy rash

Nappy rash is a very common problem for babies and is a form of intertrigo. There are ways to prevent it from developing:

• Change nappies regularly
• Keep skin as clean and dry as possible
• Bathe the baby daily and ensure they are properly dry
• Try to let the area be nappy-free for some time to let the skin breathe
• Do not use powder or scented soaps and washes
• Use a good quality disposable nappy 
• Do not use baby wipes

Treatment approaches

Treatment of intertrigo should generally focus on the removal of predisposing factors, followed by the appropriate use of topical or systemic antimicrobial agents(drugs that treat infection) as well as low-potency steroids if required.³ 

• Topical antifungal or antibacterial creams
• Steroid creams for inflammation
• Oral antibiotics in severe cases
• Lifestyle adjustments such as keeping mobile, wearing loose clothing, keeping the area dry, losing weight
• Enhanced hygiene, such as washing more regularly and especially after exercise 
• Regular monitoring and care of skin folds
  

Consulting a healthcare professional

When to seek medical advice

You should seek medical advice when symptoms seem to be getting worse or not going away even when you have been taking actions to treat. 

The doctor can usually diagnose your intertrigo by its appearance alone. There are generally no special tests required. 

You should also seek medical advice if you notice signs of infection such as inflammation, heat, foul odour, pus or raised temperature.

Importance of medical evaluation

Medical evaluation with a doctor can establish whether there is an infection or whether the condition is something other than intertrigo. It will allow the doctor to decide on a full treatment plan, which may involve prescription creams or oral medication and arrange for follow-up as required. This will also help to prevent further complications and allow the doctor to rule out other causes of the skin condition.

FAQs

1. Is intertrigo contagious? 

Intertrigo is not infectious and cannot be passed from one person to another but the condition itself can become infected and may require medication. 

2. Do I have to see a doctor for intertrigo?

You do not generally need to see a doctor when you notice signs of intertrigo unless you notice signs of infection such as pus, weeping, high temperature, or foul smell. Your local pharmacist may also be able to advise you on over-the-counter medications and prevention strategies.

3. Can I prevent intertrigo?

You can generally prevent intertrigo by washing and drying regularly, keeping skinfold areas dry and ventilated where possible, and maintaining a healthy weight. 

Summary

Intertrigo is a skin condition that often occurs in areas where there are skin folds, moisture and lack of ventilation such as under the breasts, armpits or groin. It is also common in babies in the form of nappy rash. 

Normally, it can be prevented by keeping the area dry, ventilated and clean and maintaining a healthy weight.

It can sometimes lead to fungal or bacterial infection which may need to be treated with creams or oral medication to prevent further complications.