An Overview of Intertrigo

Prevention is key to avoiding this unpleasant and uncomfortable rash

An illustration of the Candida albicans fungus.
An illustration of the Candida albicans fungus. MedicalRF.com/Getty Images

Intertrigo (intertriginous dermatitis) is an inflammatory rash that occurs between skin folds—areas of the body where skin touches skin, such as the armpits, the groin, under breasts, or within fat folds—as a result of friction, moisture, and lack of airflow. Because these folds are warm and moist, they provide ideal conditions for Candida albicans (yeast), other fungi, or bacteria to take hold, infecting the rash and worsening symptoms.

Symptoms

Intertrigo is characterized by an intensely red, macerated, glistening rash with scaling on the edges. The rash extends just beyond the limits of the opposing skin folds. Satellite lesions (small areas of the same rash that are close to the main one) are characteristic of intertrigo and Candida skin infections. Intertrigo manifests itself as diaper rash in babies and incontinent adults; urine and feces can aggravate an existing rash and make healing difficult. 

The rash can cause itching, burning, and stinging. Worsening symptoms suggest that the area has become infected with yeast or bacteria, and crusting, erosions, and other complications can occur as a result. In severe cases, infected areas may ooze or emit a foul odor.

In people with diabetes, infectious intertrigo may result in cellulitis, a potentially serious infection that can cause red streaks, fever, nausea, and vomiting.

Causes

You are at risk for getting intertrigo if you:

  • Are overweight or obese
  • Have diabetes
  • Have psoriasis
  • Are incontinent and wear diapers
  • Have a suppressed immune system due to chemotherapy or HIV
  • Wear a splint, brace, or prosthetic limb 

Hot, humid weather can cause intertrigo, especially in those who have other risk factors. Wearing tight, abrasive underclothing or dirty or sweaty clothing in general increases your risk, as does poor hygiene or not showering or bathing daily, especially after exercise. Skin that is exposed to urine or feces is also more vulnerable to infection.

Intertrigo may be a side effect of certain medications, so talk to your doctor about making adjustments if you think any drug you're taking may be a factor. If you have psoriasis, speak to your doctor about how to better manage that condition to prevent intertrigo from developing.

Diagnosis

The majority of cases of intertrigo can be diagnosed based on the rash's characteristic appearance and consideration of your risk profile.

If there is any question about the diagnosis, a KOH test—in which dead skin cells are scraped on to a slide, mixed with a potassium hydroxide solution, and heated before being examined under a microscope—can be performed to detect the presence of yeast (this is a painless procedure). A bacterial culture can help diagnose a secondary bacterial infection, if present.

Treatment

Uncomplicated, uninfected intertrigo can be treated with barrier ointments, such as petrolatum (Vaseline) and zinc oxide (Desitin). Applying cotton compresses saturated with drying solution such as Burow's solution to the skin folds for 20 to 30 minutes several times a day can also help the rash heal.

For Candida and other fungal infections, topical creams are used; some come in both over-the-counter and prescription strengths. These include:

  • Ecoza, Spectazole (econazole)
  • Extina, Nizoral A-D (ketoconazole)
  • Lotrimin AF (clotrimazole)
  • Micostatin Topical, NyStop (nystatin)
  • Oxistat (oxiconazole)
  • Zeabsorb AF (miconazole)

Antibiotic ointments, available by prescription, are typically used for bacterial infections. These include:

  • Bactroban (mupirocin)
  • Erymax, Romycin (erythromycin)

Your doctor may also prescribe a topical steroid cream, such as hydrocortisone, to reduce itching. In some cases, oral antifungals and antibiotics are necessary to cure the infection.

Prevention

Prevention is key. Once intertrigo sets in, it can be difficult to cure unless the root causes (such as obesity) are addressed. To prevent infection, take the following measures:

  • Keep the skin folds as dry as possible
  • Change out of sweaty clothes as soon as possible after exercising
  • Use an antiperspirant to keep armpits dry 
  • Wash daily with an antibacterial soap 
  • Apply antifungal powder to susceptible areas
  • Dry off well after bathing or showering
  • Reduce skin-to-skin contact 
  • Wear loose, soft underclothing instead of tight bras and underwear
  • Wear a supportive bra if the skin under the breasts is infected
  • Change diapers frequently and clean the area well
  • If you have diabetes, make sure your blood sugar is well-controlled

A Word From Verywell

Intertrigo can be uncomfortable and stubborn, so try to be vigilant about taking preventive measures and doing what you can to eliminate risk factors that are within your control. Even if you're certain that the skin condition is the culprit for your discomfort, it's best to consult a physician to get a proper diagnosis and an effective treatment plan.

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View Article Sources
  • Intertrigo. American Academy of Family Physicians. https://familydoctor.org/condition/intertrigo/.
  • Intertrigo. MedlinePlus. https://medlineplus.gov/ency/article/003223.htm.