Intertrigo Management Guidelines

Primary Management Strategies

Keeping the affected area clean and dry is the most important intervention for successful treatment 1

Topical antifungal agents are the first-line treatment for candidal intertrigo, including azoles such as clotrimazole cream and miconazole cream, and polyenes such as nystatin cream or powder 1
For extensive or resistant cases of candidal intertrigo, oral antifungal therapy may be considered, including fluconazole 100-200 mg daily for 7-14 days and itraconazole solution 200 mg daily 1
When bacterial infection is suspected, topical antibacterial agents should be used, including mupirocin ointment and clindamycin lotion 1
For suspected MRSA involvement, consider doxycycline, trimethoprim-sulfamethoxazole, and for bullous and nonbullous impetigo, topical mupirocin or retapamulin twice daily for 5 days 1, 2

For patients with obesity, diabetes mellitus, or immunocompromised status, more aggressive management is required as these conditions contribute to development and persistence of intertrigo 1
Consider maintenance therapy with intermittent application of topical antifungals for recurrent cases 1

Implement basic hygiene measures, including keeping the area dry and wearing appropriate clothing, and apply topical antifungal for suspected candidal infection or antibacterial for suspected bacterial infection 1
For persistent or extensive cases, consider oral antifungal therapy 1
For recurrent cases, implement maintenance therapy and investigate potential sources of reinfection 1

The American Academy of Dermatology recommends using low-potency topical corticosteroids or calcineurin inhibitors, such as tacrolimus 0.1% or pimecrolimus, as steroid-sparing agents for intertriginous areas in patients with psoriasis 3, 4
High-potency corticosteroids should be avoided in skin folds due to increased risk of atrophy and systemic absorption, according to the American Academy of Dermatology 3
Tacrolimus 0.1% ointment can be considered for inverse psoriasis, with 65% of patients achieving clear or almost clear skin after 8 weeks, as reported by the American Academy of Dermatology 4
Calcineurin inhibitors are particularly useful for prolonged use (≥4 weeks) in thin-skinned intertriginous areas, as suggested by the American Academy of Dermatology 4