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Author: Hon A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand, 1998. Revised and updated August 2015.

What is intertrigo?

Intertrigo describes a rash in the flexures or body folds, such as behind the ears, in the folds of the neck, under the arms (axillae), under a protruding abdomen, in the groin, between the buttocks, in the finger webs or toe spaces.

Although intertrigo may affect one skin fold, it is common for it to involve multiple sites.

Who gets intertrigo?

Intertrigo can affect males and females of any age. It is particularly common in people that are overweight or obese (see metabolic syndrome). Other contributing factors are:

What are the clinical features of intertrigo?

Intertrigo can be acute (recent onset), relapsing (recurrent), or chronic (present for more than 6 weeks). The exact appearance and behaviour depends on the underlying cause or causes.

The skin affected by intertrigo is inflamed, ie reddened and uncomfortable. It may become moist and macerated, leading to fissuring (cracks) and peeling.

What is the cause of intertrigo?

Intertrigo is due to genetic and environmental factors.

The microorganisms that are normally resident on flexural skin, the microbiome, include corynebacteria, other bacteria and yeasts. These multiply in warm moist environments and may cause disease.

We can classify intertrigo into infectious and inflammatory origin but there is often overlap. Infections tend to be unilateral and asymmetrical. Inflammatory disorders tend to be symmetrical affecting armpits, groins, under the breasts and the abdominal folds, except atopic dermatitis, which more often arises on the neck, and in elbow and knee creases.

Infections causing intertrigo
Skin diseaseCauseDescriptionImage
Thrush Candida albicans
  • Rapid development
  • Itchy moist peeling red and white skin
  • Small superficial papules and pustules
Intertrigo due to candida infection
Erythrasma Corynebacterium minutissimum
  • Persistent brown patches
  • Minimal scale
  • Asymptomatic
Axillary erythrasma
Tinea cruris (groin)
Athletes foot (between toes)
Trichophyton rubrum
T interdigitale
  • Slowly spreads over weeks to months
  • Irregular annular plaques
  • Peeling, scaling
Tinea cruris
Other infections common in skin flexures
Impetigo Staphylococcus aureus
Streptococcus pyogenes
  • Rapid development
  • Moist blisters and crusts on red base
  • Contagious, so other family members may also be affected
Impetigo in axilla
Boils Staphylococcus aureus
  • Rapid development
  • Very painful follicular papules and nodules
  • Central pustule or abscess
Boil in axilla
Folliculitis Staphylococcus aureus
  • Acute or chronic
  • Superficial tender red papules
  • Pustules centred on hair follicles
  • May be provoked by shaving, waxing, epilating
Folliculitis in axilla
Common inflammatory skin conditions causing intertrigo
Skin diseaseDescription
Flexural psoriasis
  • Well-defined smooth or shiny red patches
  • Very persistent
  • Common in submmamary and groin creases
  • Symmetrical involvement
  • May fissure (crack) in the crease
  • Red patches on other sites are scaly
Intertrigo due to psoriasis
Seborrhoeic dermatitis
  • Ill-defined salmon-pink thin patches
  • Common in axilla and groin creases
  • Fluctuates in severity
  • May be asymmetrical
  • Often unnoticed
  • Red patches on face and scalp tend to be flaky
Intertrigo due to seborrhoeic dermatitis
Atopic dermatitis
  • First occurs in infancy
  • Common in elbow and knee creases
  • Characterised by flares
  • Very itchy
  • Acute eczema is red, blistered, swollen
  • Chronic eczema is dry, thickened, lined (lichenified)
Flexural eczema
Contact irritant dermatitis
  • Acute, relapsing or chronic
Irritants include:
  • Body fluids: sweat, urine
  • Friction due to movement and clothing
  • Dryness due to antiperspirant
  • Soap
  • Excessive washing
Contact irritant dermatitis due to urine. Napkin dermatitis in adult.
Contact allergic dermatitis
  • Acute or relapsing
Allergen may be:
  • Fragrance, preservative or medicament in deodorant, wet-wipe or other product
  • Component of underwear (rubber in elastic, nickel in bra wire)
Intertrigo due to contact allergy to benzocaine
Hidradenitis suppurativa
  • Chronic disorder
  • Boil-like follicular papules and nodules
  • Discharging sinuses and scars
Intertrigo due to
Uncommon chronic inflammatory skin conditions in skin flexures
Hailey-Hailey disease
  • Intermittent painful shallow blisters that quickly break down
  • Rare inherited condition
  • Often starts age 20–40 years
  • Most troublesome during summer months
Intertrigo due to Hailey-Hailey disease
Granular parakeratosis
  • Red brown scaly rash
  • May be itchy
  • Rare
  • Biopsy essential for diagnosis
Fox-Fordyce disease
  • Dome-shaped follicular papules in armpits
  • Often persistent
  • Asymptomatic or itchy
  • Reduced sweating
Axillary Fox-Fordyce disease

What investigations should be done?

Investigations may be necessary to determine the cause of intertrigo.

What is the treatment for intertrigo?

Treatment depends on the underlying cause, if identified, and on which micro-organisms are present in the rash. Combinations are common.

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