What Is Intertrigo

Intertrigo is a common skin condition characterised by inflammation and irritation of the skin folds - appearing as a rash - and is commonly caused by friction, moisture, and poor ventilation. It usually affects areas where the skin surfaces rub together, such as the armpits, inner thighs, and under the breasts. In many cases of intertrigo, damage to the skin surface causes bacteria and/or fungi to overgrow, resulting in secondary infections.¹

Intertrigo most frequently affects the following areas of the body:

• Groin
• Axillae (underarms)
• Inframammary folds (under the breasts)
• Inner thigh areas
• Antecubital fossae (inner elbows)
• Umbilical area
• Perineal area
• Interdigital areas (between the fingers or toes)
• Neck creases

Overview

Intertrigo is a common skin condition that occurs in skin folds and is associated with factors such as warm temperature, friction, moisture, and lack of airflow. Individuals who are overweight, have diabetes mellitus or sweat excessively are more likely to experience intertrigo. Tight clothing and poor hygiene can contribute to this condition. Although intertrigo is not contagious, it can lead to discomfort and irritation.

This article outlines the causes, symptoms, risk factors, diagnosis, treatment, and prevention strategies for intertrigo.

Causes of intertrigo

The causes of intertrigo are primarily associated with factors that contribute to skin-on-skin friction and excessive moisture in skin folds.

It can be triggered and aggravated by various factors, including:

• Moisture: Excess moisture from sweat, urine, or faeces in the skin folds can contribute to intertrigo development.
• Lack of circulation: Insufficient air circulation on the skin surface can create an environment favourable for intertrigo, increasing the risk of bacterial or fungal infections.
• Friction: Repeated rubbing or chafing of the skin can lead to skin breakdown, providing an entry point for bacteria and yeasts. 
• Prolonged immobilisation or limited mobility: Bedridden or debilitated individuals are more prone to intertrigo due to prolonged periods of immobility and inadequate air circulation in the skin folds.
• Heat: Increased temperatures promote sweating and moisture accumulation, making intertrigo more prevalent in hot weather or hot climates.
• Poor hygiene: Poor hygiene practices can lead to the accumulation of bacteria and yeast on the skin surfaces, contributing to the development of intertrigo.

The most common type of fungal infection that can cause intertrigo is Candida. Candida can develop excessively and cause an infection when the skin in regions such as the groin, armpits, and beneath the breasts gets warm and moist, as it provides a favourable environment for Candida to develop.²

Signs and symptoms of intertrigo

The signs and symptoms of intertrigo include the following:

• Reddish-brown rash
• Itching/burning sensation in the affected area
• Split skin
• Inflammation
• Soreness/Discomfort
• Cracked/crusty skin
• Raised, tender bumps on the skin containing pus
• In severe cases, intertrigo can result in bacterial infection, leading to a foul odour, skin cracking, and bleeding.

Management and treatment for intertrigo

The management and treatment for intertrigo typically involve several approaches to address the inflammation, infection, and protection of the affected skin surfaces, depending on the severity of the rash. Some common treatment options include:

• Keep the affected skin dry and clean: The foremost step in managing intertrigo is to reduce moisture in and around the skin folds. This can be achieved by keeping the high-risk areas clean and dry through regular washing and thoroughly drying the skin after bathing or sweating.
• Barrier cream: Applying a barrier cream can help protect the skin surfaces from irritants and minimise friction in the affected area.
• Wear loose-fitting clothing: Tight clothing can trap moisture and heat, exacerbating intertrigo. Wear light, absorbent clothing that is comfortable and made of breathable fabrics, such as cotton. Fabrics made of nylon and other synthetic fibres should be avoided.
• Antifungal or antibiotic cream/ointment: If intertrigo becomes infected, a doctor may prescribe appropriate antifungal or antibiotic cream/ointment based on the identified cause and microorganisms present in the rash to treat the infection and promote healing.
• Topical steroids: In certain cases, topical steroids may be administered to relieve inflammation in the affected area. These medications are usually recommended by a doctor and should be used as directed.
• Antiperspirants: Applying antiperspirant cream or powder to the affected skin folds as directed can assist in managing excessive sweating and potentially alleviate symptoms of intertrigo.
• Oral medication: In certain situations, oral medications may be required to treat severe or persistent intertrigo, especially if the infection has spread or if topical treatments have proven ineffective.
• Treat any underlying medical conditions: If you have diabetes or another condition that makes you more likely to get intertrigo, treating the underlying condition can help prevent the rash from recurring.³

Diagnosis

The diagnosis of intertrigo primarily involves a clinical evaluation and examination of the affected skin folds. In some cases, additional tests such as microscopy and culture of bacteria and fungi, histopathology, and KOH test may be conducted to confirm the diagnosis or identify underlying causes. These tests aid in identifying the presence of bacterial or fungal infections and assess the skin condition if it does not improve with treatment.⁴

Risk factors

Certain factors can increase the risk of developing intertrigo, although it can affect people of all ages and body types.

• Being overweight or obese: Excess weight can lead to the formation of skin folds, where moisture can accumulate, and friction can occur between the skin surfaces.
• Wearing tight-fitting clothing: Tight clothes can create friction and trap moisture between the skin folds, increasing the likelihood of intertrigo. 
• Having diabetes: Diabetes can cause elevated blood glucose levels, which can lead to increased moisture on the skin. This heightened moisture can contribute to the development of intertrigo.
• Immunocompromised status: Individuals, including those with conditions like HIV infection, undergoing chemotherapy, or taking systemic steroids, have a weakened immune system, which makes them more susceptible to infections, including intertrigo.
• Hyperhidrosis (Excessive sweating): Excessive sweating can keep the skin moist, heightening the risk of intertrigo.
• Diapers: Babies are prone to intertrigo (Diaper rash), due to their delicate skin, constant moisture from drooling, and wearing diapers that create a warm and humid environment favourable for bacterial and yeast growth.

Complications

If left untreated, intertrigo can result in various complications, including:

• Infection: Intertrigo creates an optimal environment for bacterial or yeast growth, leading to infection. It can worsen symptoms and cause crusting, erosion, foul odour from the infected areas, and potential further complications.
• Cellulitis: Bacterial infections in the intertrigo, especially in individuals with diabetes, can progress to cellulitis, a serious condition that affects the skin and soft tissues.
• Sepsis: Untreated intertrigo infections can potentially lead to sepsis, a life-threatening condition characterised by a systemic response to infection that can damage organs and tissues.
• Nail fungal infections: Intertrigo between the toes or fingers can contribute to the development of fungal infections in nails.

FAQs

How can I prevent intertrigo?

To prevent intertrigo, it is crucial to maintain proper hygiene and keep the affected areas clean and dry. After bathing or showering, gently pat dry the skin folds and apply a thin layer of barrier cream or powder to reduce friction and moisture. Opt for loose-fitting, breathable clothing to allow air circulation and avoid tight or restrictive garments. Consider using absorbent pads or dressings in areas prone to excessive sweating or rubbing. Take regular breaks from activities that cause excessive sweating or friction, and maintain a healthy weight to minimise skin-to-skin contact/chafing.

How common is intertrigo?

Intertrigo is a relatively common skin condition, with its prevalence varying among different populations and geographic regions. It is more frequently observed in regions with hot and humid climates, where increased sweating and skin friction are common. Individuals with diabetes and obesity are more susceptible to developing intertrigo infections.

What can I expect if I have intertrigo?

If you have intertrigo, you can expect symptoms such as a reddish-brown rash on the skin, a burning sensation in the affected area, itching, and discomfort. The severity of these symptoms can vary based on your skin type, the area of the body affected, the degree of the rash, and the presence of an underlying condition. It is important to seek proper treatment and management to alleviate discomfort and promote healing.

When should I see a doctor?

It is advisable to seek medical attention in the following situations:

• If the intertrigo rash is severe, painful, or shows signs of infection, such as a foul odour or the presence of pus.
• If the rash does not improve or worsens despite home remedies and self-care.
• If you have a weakened immune system, uncontrolled diabetes, or a history of recurrent intertrigo.

Consulting a healthcare professional in these cases will ensure proper evaluation and appropriate treatment.

Summary

In conclusion, intertrigo is a common skin condition that occurs in skin folds, often due to factors such as moisture, friction, and heat. It can cause red, bumpy rashes, itching, and discomfort. Effective management and treatment strategies involve maintaining proper hygiene, keeping the affected areas dry, using barrier creams, wearing loose clothing, and seeking medical advice for possible antifungal or antibiotic creams, topical steroids, or oral medications. Preventive measures include practising good hygiene, wearing breathable clothing, and addressing underlying medical conditions. By following these approaches, individuals can alleviate symptoms, reduce the risk of complications, and prevent the recurrence of intertrigo.