By Gary M. White, MD
This intertrigo was secondarily infected with Streptococcus.
Intertrigo is inflamed skin of the body folds caused by chronic heat and sweat.
The skin of a body fold becomes red and scaly. Itching is typical. In severe cases, the skin may become macerated. Obese women with large breasts exposed to hot, humid climates or men whose groins stay hot and sweaty are typical patients. Secondary infection by candida is very common and its presence is indicated by satellite pustules. Alternatively, bacterial overgrowth, e.g., streptococcus (as pictured above) may be found.
The patient must be educated on the cause of the rash. Specifically, s/he must understand that any skin does best if kept cool and dry. Typical discussion points include: Does the affected skin stay hot and sweaty? What can be done to keep the affected skin cool and dry? What is the patient's profession? How hot does s/he get during the day? Does s/he have air conditioning at work? At home? It is best to recommend that the patient shower after any exercise and use a blow dryer to dry the area daily before dressing. What sort of underclothes are worn? For men, would boxers be better than briefs?
If any secondary infection is present, it should be treated followed by a topical steroid cream or solution to reduce the inflammation. Cool soaks BID may help dry a moist, oozing eruption. A steroid cream with added nystatin is helpful in areas where candida is common, e.g., the inframammary area or the angles of the lips.
Long-term, to prevent recurrences, the area must be kept dry. One of the best ways is to use a blow dryer after the shower to completely dry the area. Then apply a roll-on antiperspirant. Treat the area like the armpit!
Diluted bleach can be excellent when a body fold becomes moist, itchy and presumably full of bacteria. This approach is good for, e.g., under a large pannus or in the groin. Have the patient mix a solution of 40:1 water to bleach. Soak a washcloth and apply to the affected area. Let dry. Do just once and it can soothe and heal the area for days to weeks.
A super absorbent powder (e.g., Zeasorb) every morning may also be helpful. Some of these products have miconazole or other antifungal powder included. In extreme cases, a strip of an old white sheet or other cloth may be placed in the folds to absorb moisture.
Some athletes can get an irritation in the groin from the friction that occurs with exercise. Olive or other oil applied before workouts to decrease friction may be tried.
Intertrigo in an obese male.
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