Intertrigo: Treatment, Signs, Pictures, and Prevention

Intertrigo starts as redness or small bumps or spots in skin folds. The rash can feel:

• itchy
• uncomfortable
• burning
• prickly
• painful

The intertrigo appears on both sides of the skin fold, almost like a mirror image. If it's not infected, the rash is usually symmetrical. For example, it may appear under both arms or both breasts.

The reddish area can quickly become inflamed and raw. The skin may crack, bleed, ooze, and crust over. The surrounding area may become scaly.

If you have a secondary infection from bacteria, fungus, or yeast, the intertrigo becomes more inflamed and can develop a bad smell. Intertrigo with a secondary infection is often asymmetrical (not even or present on both sides).

You may have intertrigo in more than one skin area. Also, smaller skin fold areas, such as behind your ears, around your chin, or your eyelids can be affected.

Intertrigo symptoms get worse when the area comes in contact with your bodily secretions, such as sweat, urine, or feces.

Intertrigo is common and can occur at any age, but it's more common in the very young and in older people. In babies, intertrigo most often appears as diaper rash.

People with a weakened immune system or who are incontinent or bedridden are more likely to have intertrigo. It's also more common in hot and humid weather.

Treatment for intertrigo is usually a skin cream and a good home hygiene regimen to keep the area clean and dry. The type of topical drug depends on whether bacteria, fungus, or yeast are involved. In more severe cases, you may need to take an oral medication.

When intertrigo is inflammatory only, with no infection, treatment is straightforward: Keep the area clean and dry and follow some of the home remedy suggestions below.

There are also several solutions that may help to control the intertrigo. Your doctor may suggest that you use:

• zinc oxide ointment
• petroleum jelly (Vaseline)
• talcum powder
• aluminum sulfate

If you have an infection with the intertrigo, your doctor will prescribe specific topical creams.

Your treatment for intertrigo will depend on the cause and the type of infection you have. We'll go over bacterial and yeast infections below.

In extreme cases, some women have undergone breast reduction surgery to reduce chronic intertrigo.

Keep it clean and dry

The number one rule is to keep the area clean and dry.

If you exercise, shower afterwards and pat yourself dry. Don't rub your skin. You may want to dry off the affected areas with a hair dryer set on low.

Other products, such as tea tree oil or coconut oil, may help reduce itching and prevent infection, including in your buttocks area.

Use anti-chafing or barrier gels

If the intertrigo is inflammatory only, without an infection, use over-the-counter creams to create a barrier between the skin folds. Creams or ointments with zinc oxide or petrolatum can be useful. There are also anti-chafing balms that come in stick form.

Block the sweat

Use a mild antiperspirant to stop sweating, including under your breasts.

Wash with antifungal shampoos

If you have a fungal infection, try using use an antifungal shampoo (such as Nizoral AD) as soap on the affected area. Leave it on for two to five minutes and then rinse. After the rash heals, use the shampoo on the area at least weekly.

Create a physical barrier

Depending on the affected area, use a thin cotton or gauze barrier to separate the skin folds.

Wear loose clothing and breathable fabrics

Wear loose cotton clothing next to your skin and avoid synthetic materials that can be irritating.

Topical antifungals used for intertrigo are nystatin and azole drugs, including miconazole, ketoconazole, or clotrimazole.

You usually use the cream twice a day for two to four weeks.

If your rash is very itchy, the doctor may also prescribe an antifungal combined with a low-dose corticosteroid.

Depending on the severity of the infection, your doctor may prescribe a systemic antifungal drug that you'd take by mouth.

Topical antibiotics are used for bacterial infections. These include fusidic acid cream or mupirocin (Bactroban).

If the infection is more severe, the doctor may prescribe an oral antibiotic, such as penicillin, flucloxacillin, or erythromycin.

The doctor may also prescribe a low-potency corticosteroid and advise you to use an antibiotic soap.

Intertrigo in babies requires special care, because the affected skin area is so delicate. Keep the area clean, wash it gently with a mild soap, and pat it dry.

Use an absorbent diaper and wrap it loosely. Consider changing diapers on a schedule which may decrease the amount of time your baby is in a wet diaper. Over-the-counter creams, such as those with zinc or cod-liver oil may be useful.

If the diaper rash looks infected or doesn't go away in a few days, see your doctor.

If you or your child have a skin rash that doesn't go away, or that rapidly gets worse, see your doctor. Skin rashes can have many causes and the treatment is often very specific. You should also see your doctor if you're being treated and the rash isn't getting better.

Red rashes can have many different causes. Your doctor will want to rule out other possibilities, such as psoriasis or allergic reactions.

If they suspect it's intertrigo and an infection, they'll also want to test for a fungal, bacterial, or viral cause of the infection. To help identify the cause, they may take a scraping or swab of the rash to look at under a microscope or to culture. Or they may look at it under a special lamp.

Few scientific studies of intertrigo have measured what works and what doesn't to prevent it. But there are preventive measures you can take that are likely to work for you:

• Keep the skin area clean, dry, and aerated.
• Maintain a skin care routine of cleaning, moisturizing, and applying a skin barrier to protect the area.
• Use fragrance-free soaps and other skin products to minimize irritation.
• Use a powder, such as Zeasorb AF, on the area once or twice a day.
• Minimize exposure to sweat, urine, or feces. If you're incontinent, use special products to absorb moisture.
• Use a dehumidifier if you live in humid conditions.
• Use an air-conditioner to avoid being in high heat.
• If you have diabetes, keep it under control.
• Exercise then dry off and cool down afterward.
• Don't wear tight clothing or shoes that can constrict the affected area. If your toes are affected, wear open-toe shoes.
• Wear cotton next to your skin.

The main cause of intertrigo is the irritation of skin rubbing against skin.

These areas are often moist, warm, and lacking air exposure. This makes them perfect breeding areas for microorganisms. These bacteria or fungi worsen the rash and its symptoms.

Secondary intertrigo infections could include:

Fungi

Candida (a yeast) is the fungus group that's most commonly associated with intertrigo. About 80 percent to 90 percent of all skin yeast infections are caused by Candida albicans (also called thrush).

Most people normally have some Candida albicans present on their skin, so the yeast can easily take advantage of skin breaks to proliferate. A Candida rash is very bright red and raw looking.

Bacteria

Bacteria associated with intertrigo include:

• Staphylococcus aureus
• group A beta-hemolytic streptococci
• Pseudomonas aeruginosa
• Proteus mirabilis
• Proteus vulgaris

Viruses

The most common viruses associated with intertrigo are:

• Poxviridae
• Papillomaviridea (human papilloma virus or HPV)
• Picornaviridae
• Retroviridae (HIV)
• Herpesvirdae
• Togaviridae
• Parvoviridae

In some cases, intertrigo occurs as a side effect of chemotherapy treatment.

Anyone can get intertrigo, but some conditions can increase your risk. You're more at risk if:

• you have a weakened immune system
• you have excess skin
• you have diabetes
• you have poor hygiene habits
• you're immobile
• you're incontinent
• you wear a splint, brace, or an artificial limb that rubs your skin
• you live or work in high heat and humidity
• you sweat excessively (hyperhidrosis)
• you're malnourished
• your clothing or shoes are too tight

Infants are also at a higher risk, because their skin is more sensitive. They also tend to have skin rolling against itself (like the folds of the neck), and are more likely to have damp skin from drooling and from wearing diapers.

Intertrigo is a common and treatable condition. It has a good prognosis in people who are otherwise healthy. If a secondary infection is involved, it's important to treat the cause until the symptoms are gone.

In some cases, intertrigo can become chronic. Maintaining a good skin cleaning and moisturizing routine can help prevent intertrigo from coming back.

See a doctor to determine what's causing the infection and receive the appropriate remedies.