Intertrigo

What is Intertrigo?

Intertrigo is a fungal, viral or bacterial infection that occurs where there is broken skin due to an inflammation. It is simply put, a rash of the body folds. The folds include under the breasts, between the toes and fingers, the inner thighs, under the belly, neck crease, armpits and behind the ears. It is caused by chaffing of moist warm skin, maceration and lack of air circulation. It normally is red in color and it may itch.

It is mostly common in people that are restricted to bed rest and those that are overweight. Some diseases also cause the occurrence of this condition. The areas of the skin that come into contact with each other are referred to as intertriginous zones, hence the name. In infants the condition often appears as diaper rash. ¹

Causes of Intertrigo

It is caused by a combination of temperature increase, friction, lack of air circulation and moisture which are the mechanical factors³. It can however be more complicated and this is by things such as allergies, yeasts fungi and bacteria and these are the secondary factors³. Factors such as urine, feces and sweat are other contributing factors to the condition⁵.

The folds of the body is where this condition is more predominant as the places have all the combined factors the infection needs to grow.

The skin surfaces rub on each other creating friction and hence inflammation occurs. The infection is however not contagious and cannot be passed on from one person to another².

Symptoms and Features

The most common areas to look for any signs and symptoms of Intertrigo include:⁵

In the inner thigh
In the neck crease
Between fingers and toes
On the underside of the breast and belly
In the groin and scrotum
In the armpits
Between the buttocks

The condition normally appears to be:

Red or brown or both red and brown rashes
Raw, itchy or oozing skin
Cracked or crusty or scaly skin
Foul odor
Pain in the areas mentioned above
A stinging sensation
A burning sensation of the skin
Weeping of the skin
Erosion of the lesions
Maceration of the skin

The condition may however worsen into secondary cutaneous infection.

Diagnosis

The condition can be diagnosed by using basic skin test to find out the cause of the condition and guide the therapy moving forward⁵. Tests like gram test and potassium hydroxide tests are useful in excluding either primary or secondary infection and to guide in the treatment. A skin biopsy is only done if the condition is only worsening and not responding at all to medication⁵.

Alternatively the appearance may be diagnosed by a medical professional. It appears as a red or brown rash affecting one or more intertriginous zones on the body. If however the condition does not seem to be responding to medication in this case a referral is made to a dermatologist⁴.

Complications

In some very rare occasions it may cause appearance ofsecondary cutaneous infections and acute cellulitis can occur³.Varying microorganisms can complicate the infection and they need to be eliminated before treatment can begin⁴.

Fungal infections are very prone to occur in the affected area and hence the tests such as scrapping the affected area and examining the scrapped cells microscopically are very crucial and important to perform to exclude and prevent this problem⁴.

Some doctors and most dermatologists are well within their means and able to perform potassium hydroxide tests on scales from the area that has been affected by the Intertrigo right in their offices or clinics and examine visually under a microscope⁴. The ability to see these microorganisms should be used to prevent the complication of the infection.

Treatment

It is mostly treated by addressing the causing agents of the condition such as moisture and the fungi and bacteria¹.

Keeping the area dry and providing it with enough air circulation can prevent the condition. This can be done by use of cornstarch or baby powder or antiperspirant as an alternative.
Grease cream may also be used as a barrier to the moisture. Short term use of steroid cream may be recommended to reduce the inflammation².
Diaper rash ointment in children can also be used. The antifungal prescriptions can also be used in cases where the main cause was fungi¹ this may be administered orally or with ointments but however this is only used in severe cases.
A drying agent such as baby powder or cornstarch are used in milder instances of the condition or infection.
The oozing may however be controlled by moist compresses with a prescribed solution which should then be dried using an air drier device set on cool.

Home Remedies

Apply a cold compress to the affected area to relieve the itchiness and the burning sensation
Using cornstarch to keep the area dry and friction free⁶
Using apple cider vinegar on the affected are. This will cause a reduction in the irritation feeling and get rid of the infection with time.
Apply coconut oil on the affected area. The oil has an antifungal acid to help heal the condition
Aloe Vera juice can be applied to the area to relieve the irritation and itchiness.
The use of baking soda is also advised as it keeps the area dry and is basic and known to give a soothing feeling where it is applied.

Prevention

To prevent any condition one must look at the causative agents and try reversing them. When it comes to the mechanical causes such as the moisture, it can easily be prevented by ensuring a use of things like antiperspirants where necessary and in more sensitive parts baby powder can be used. The powder is also a great way to keep the area from rubbing each other and causing friction.

A good bra should be worn in cases under the breast as this will ensure the area is exposed and air circulation is taking place sufficiently. Grease is also another option to prevent the occurrence of Intertrigo since it is great at prevention of friction as it acts as a lubricant and on top of that it is also very hard to mix oil and water hence it keeps away the moisture from the areas that it is applied.

As always the need for hygiene is important in this case seeing as it successfully keeps away bacteria from the skin and fungi that are known secondary causing agents for this infection. The losing of excess weight is also advised as it reduces the number of intertriginous zones. In babies, the use of a baby powder in the diaper is advised to prevent the occurrence of diaper rash.

Pictures

References

Intertrigo – https://en.wikipedia.org/wiki/Intertrigo
https://familydoctor.org/condition/intertrigo/
http://emedicine.medscape.com/article/1087691-overview
http://www.medicinenet.com/intertrigo/page2.htm
http://www.webmd.com/skin-problems-and-treatments/guide/intertrigo-symptoms-causes-treatment-risk_factors_#1
Intertrigo – http://www.rapidhomeremedies.com/rashes-under-breast.html

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