Candidal intertrigo

What is candidal intertrigo?

Candidal intertrigo refers to superficial skin-fold infection caused by the yeast, candida.

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What causes candidal intertrigo?

Candidal intertrigo is triggered by a combination of the following factors:

• The hot and damp environment of skin folds, which is conducive to the growth of candida species, particularly Candida albicans[1] 
• Increased skin friction [2]
• Immunocompromise [3].

Who gets candidal intertrigo?

Factors that increase an individual's risk of developing candidal intertrigo include:

• Occlusive clothing, gloves and footwear
• Obesity
• Excessive sweating (hyperhidrosis)
• Incontinence causing irritant contact dermatitis
• Diabetes mellitus
• Immune deficiency conditions, such as human immunodeficiency virus infection (HIV) or immune suppression by medications (chemotherapy, systemic corticosteroids) [2-5].

What are the clinical features of candidal intertrigo?

Candidal intertrigo classically presents as erythematous and macerated plaques with peripheral scaling. There are often associated superficial satellite papules or pustules [2,5,6].

Affected areas may include: 

• Skin folds below the breasts or under the abdomen
• Armpits and groin
• Web spaces between the fingers or toes (erosio interdigitalis blastomycetica) [2,5,6]. 

How is candidal intertrigo diagnosed?

Diagnosis of candidal intertrigo requires recognition of consistent clinical features. In cases of uncertainty, confirmation can be sought by way of fungal microscopy and culture of skin swabs and scrapings [7]. Skin biopsy is usually not necessary.

What is the differential diagnosis for candidal intertrigo?

Other forms of intertrigo should be considered, including:

• Tinea cruris (groin) and athlete's foot (between toes)
• Contact dermatitis
• Atopic dermatitis
• Seborrhoeic dermatitis
• Flexural psoriasis
• Impetigo
• Extramammary Paget disease
• Herpes simplex
• Hailey Hailey disease.

How is candidal intertrigo treated?

• Predisposing factors should be addressed primarily, such as weight loss, blood glucose control and avoidance of tight clothing [8,9].
• Patients should be advised to maintain cool and moisture-free skin. This may be aided by regular use of a drying agent such as talcum powder, especially if infection is recurrent [7,10].
• Topical antifungal agents such as clotrimazole cream are recommended as first-line pharmacological treatments [10–12].
• Severe, generalised and/or refractory cases may require oral antifungal treatments such as fluconazole or itraconazole[10–12].