Intertrigo

Disease Description (Causes and Symptoms)

• Definition: An inflammatory rash related to friction and moisture that occurs in skin folds (under the breasts, groin, armpits, between the abdomen and thighs, etc.) (intertrigo).
• Causes/Pathophysiology: When skin surfaces come into contact, accumulate moisture, and undergo repeated friction, the epidermal barrier is damaged, causing inflammation. A moist environment promotes secondary infections with Candida (yeast) or bacteria, worsening symptoms. Risk factors include obesity, infants (diapers), diabetes, excessive sweating, and clothing that causes skin-to-skin contact.
• Main symptoms: Ill-defined erythema (redness), itching and pain, surface moisture (exudation), cracks and vesicles, crusting, or discoloration after healing. With Candida infection, erosion is mainly found in the center (red, moist lesions with an atrophic border; satellite lesions may occur when hygiene is poor).

Treatment Methods and Precautions

• Basic principles: Remove friction and moisture → treat local inflammation and infection → control underlying causes (weight management, blood glucose management, etc.).
• Topical treatment
  • Keeping the skin dry and reducing friction: Loose, breathable clothing, absorbent pads, and methods to separate skin surfaces (e.g., cotton towels) are recommended.
  • Protectants (barrier ointments): Block irritants with zinc oxide, petroleum jelly, etc.
  • Antifungals (if Candida infection is suspected): Topical azoles (clotrimazole, miconazole) or nystatin. Oral antifungals (e.g., fluconazole) may be considered if the infection is extensive or repeatedly recurrent.
  • Antibiotics: Use topical or oral antibiotics if there is a secondary bacterial infection (pustules, pus, or systemic symptoms).
  • Anti-inflammatory drugs: A low-potency topical steroid (e.g., hydrocortisone 1%) may be used for a short period, but caution is needed because long-term use can cause skin atrophy and worsen fungal proliferation.
  • Combination preparations (antifungal + steroid) should only be used for a short period and under a doctor’s direction when the causative infection is clear.
  • Powder use: Although it may help reduce friction, caution is needed because it can cause contamination and fungal growth (use it cleanly).
• Lifestyle management
  • Weight loss (for patients with obesity), diabetes control, frequent diaper changes and ventilation, and frequent washing and drying on days with heavy sweating.
• Indications for emergency or specialist treatment
  • If there are systemic symptoms (fever), rapidly progressing ill-defined erythema, purulent discharge, extensive disease, or failure to respond to treatment, dermatology evaluation and consideration of culture/systemic medication are recommended.
• Precautions
  • Do not use high-potency steroids long-term on skin folds.
  • Consult a specialist if symptoms worsen with self-treatment.
  • Patients with diabetes or immunosuppression have an increased risk of infectious complications.

Checklist Before an Outpatient Visit (What to Prepare and Example Questions)

• Items to prepare (bring with you)
  • A list of current medications (including prescriptions, OTC medications, and supplements)
  • Medical history such as diabetes and immunosuppressive treatment, and recent test results (blood glucose, HbA1c, etc.)
  • Records of when symptoms began and their course (photos are recommended), as well as factors that worsen or improve them
  • Ointments/medications previously used (types and duration of use) and their effects
  • Records of whether fever, swollen lymph nodes, pus, or an unpleasant odor is present
• Items the doctor may ask about (think about these in advance)
  • When the rash first appeared and how it has changed
  • The severity of pain and itching, and whether it affects sleep at night
  • Whether antibiotics were recently taken, and habits involving work or exercise that cause heavy sweating
  • Changes in weight and whether chronic diseases such as diabetes are present

General Example Questions to Ask the Doctor

• What are the possible side effects of this medication (the prescribed ointment/medicine)?
• How long should I use the medication? Should I continue applying it even after the symptoms have disappeared?
• What lifestyle habits should I change to reduce recurrence?
• I have diabetes. What additional management is needed to lower the risk of infection?
• When should I return if my symptoms do not improve?

Examples of Condition-Specific Questions

• I see white or yellow satellite lesions in the rash (small lesions scattered around it). Candida infection is suspected; is a topical antifungal sufficient, or will oral medication be needed?
• If weight loss is needed, can I receive a realistic weight-management plan or guidance alongside treatment (such as referral to a dietitian)?

(If necessary, skin sampling for additional diagnosis (KOH preparation, culture), blood glucose testing, and consultation with a dermatologist are recommended.)