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Author: Hon A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand, 1998. Revised and updated August 2015. Updated by Janet Dennis, November 2018. Technical Editor: Mary Elaine Luther, Medical Student, Ross University, Barbados. DermNet Editor in Chief: Adjunct A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. Copy edited by Gus Mitchell. January 2020.
Intertrigo describes a rash in the flexures, such as behind the ears, in the folds of the neck, under the arms, under a protruding abdomen, in the groin, between the buttocks, in the finger webs, or in the toe spaces. Although intertrigo can affect only one skin fold, intertrigo commonly involves multiple sites. Intertrigo is a sign of inflammation or infection.
Intertrigo can affect males or females of any age. Intertrigo is particularly common in people who are overweight or obese (see metabolic syndrome).
Other contributing factors are:
In infants, napkin dermatitis is a type of intertrigo that primarily occurs due to skin exposure to sweat, urine, and faeces in the diaper area.
Toe-web intertrigo is associated with closed-toe or tight-fitting shoes. Lymphoedema is also a cause for toe-web intertrigo.
Intertrigo can be acute (recent onset), relapsing (recurrent), or chronic (present for more than six weeks). The exact appearance and behaviour depend on the underlying cause(s).
The skin affected by intertrigo is inflamed, reddened, and uncomfortable. The affected skin can become moist and macerated, leading to fissuring (cracks) and peeling.
Intertrigo with secondary bacterial infection (eg, pseudomonas) can cause a foul odour.
Intertrigo is due to genetic and environmental factors.
The microbiome (microorganisms normally resident on the skin) on flexural skin includes Corynebacterium, other bacteria, and yeasts. Microbiome overgrowth in warm moist environments can cause intertrigo.
Intertrigo is classified into infectious and inflammatory origins, but they often overlap.
Thrush: Candida albicans
Erythrasma: Corynebacterium minutissimum
Tinea: Trichophyton rubrum + T. interdigitale
Impetigo: Staphylococcus aureus and Streptococcus pyogenes
Boils: Staphylococcus aureus
Folliculitis: Staphylococcus aureus
Irritant contact dermatitis
Allergic contact dermatitis
Investigations may be necessary to determine the cause of intertrigo.
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