Erythema intertrigo - Clinicals, Diagnosis, and Management

Dermatology

Clinicals - History

Fact Explanation
Skin lesion Intertrigo is an inflammatory rash of skinfolds caused by skin-on-skin friction. This usually occurs in opposing surfaces of a skin fold. Initially an erythema appears. The distribution of the lesion is more or less symmetrical along the mid line of the skin fold. It commonly occurs in the groin, axillae, and infra-mammary folds. Antecubital fossae, umbilical, perineal, or interdigital areas, neck creases, and folds of the eyelids are also affected. This erythema is usually ill demarcated and mild in severity. Skin lesion
Intertrigo is an inflammatory rash of skinfolds caused by skin-on-skin friction. This usually occurs in opposing surfaces of a skin fold. Initially an erythema appears. The distribution of the lesion is more or less symmetrical along the mid line of the skin fold. It commonly occurs in the groin, axillae, and infra-mammary folds. Antecubital fossae, umbilical, perineal, or interdigital areas, neck creases, and folds of the eyelids are also affected. This erythema is usually ill demarcated and mild in severity.
Itching Patients may present with intense itching, burning, and pain in the affected areas. Severe itching or pain is attributed to severe form of inflammation caused by secondary bacterial/ fungal infection. Itching
Patients may present with intense itching, burning, and pain in the affected areas. Severe itching or pain is attributed to severe form of inflammation caused by secondary bacterial/ fungal infection.
Associations/ complications Some cases may complicated with secondary infections. Staphylococcus aureus, Group A Beta-hemolytic Streptococcus, Pseudomonas aeruginosa, Proteus mirabilis, or Proteus vulgaris are the involved bacteria. Candida, yeasts, molds, and dermatophytes are also involved. Sharply demarcated erythematous areas appear as a result of mechanical causes or cellulitis caused by deep spread bacterial infections in the subcutaneous areas. Intertrigo of interweb areas, intergluteal and crural folds, axillae, or inframammary regions can rarely be complicated by erythrasma caused by Corynebacterium minutissimum. Associations/ complications
Some cases may complicated with secondary infections. Staphylococcus aureus, Group A Beta-hemolytic Streptococcus, Pseudomonas aeruginosa, Proteus mirabilis, or Proteus vulgaris are the involved bacteria. Candida, yeasts, molds, and dermatophytes are also involved. Sharply demarcated erythematous areas appear as a result of mechanical causes or cellulitis caused by deep spread bacterial infections in the subcutaneous areas. Intertrigo of interweb areas, intergluteal and crural folds, axillae, or inframammary regions can rarely be complicated by erythrasma caused by Corynebacterium minutissimum.
Risk factors Body folds that have high skin temperature, moisture from insensible water loss has a high risk of affected by intertrigo. Individuals who are obese and diabetic also carry a higher predisposition. Other predisposing risk factors include urinary and fecal incontinence, hyperhidrosis, poor hygiene, and malnutrition. Toe interweb intertrigo may be associated. People who wear losed-toe or tight-fitting shoes such as those who are participating in occupational, athletic, or recreational activities have a risk. Risk factors
Body folds that have high skin temperature, moisture from insensible water loss has a high risk of affected by intertrigo. Individuals who are obese and diabetic also carry a higher predisposition. Other predisposing risk factors include urinary and fecal incontinence, hyperhidrosis, poor hygiene, and malnutrition. Toe interweb intertrigo may be associated. People who wear losed-toe or tight-fitting shoes such as those who are participating in occupational, athletic, or recreational activities have a risk.

Clinicals - Examination

Fact Explanation
Skin redness At the initial stage patients may present with symmetrically distributed ill demarcated
plaque like erythematous skin lesions in the skin fold areas in the groin, axillae, infra-mammary folds, antecubital fossae, umbilical, perineal, or interdigital areas, neck creases, and folds of the eyelids.
Skin redness
At the initial stage patients may present with symmetrically distributed ill demarcated
plaque like erythematous skin lesions in the skin fold areas in the groin, axillae, infra-mammary folds, antecubital fossae, umbilical, perineal, or interdigital areas, neck creases, and folds of the eyelids.
Macerations Initial mild erythema may progress into severe inflammation with erosions, maceration, and crusting. Macerations
Initial mild erythema may progress into severe inflammation with erosions, maceration, and crusting.
Secondary bacterial infections Due to severe itching, intertrigo can be complicated by secondary bacterial infections. As a result, patient may have skin erosions that are oozing with exudates. Secondary bacterial infections
Due to severe itching, intertrigo can be complicated by secondary bacterial infections. As a result, patient may have skin erosions that are oozing with exudates.
Erythrasma Small, red-brown macules that may coalesce into sharply demarcated larger patches with sharp borders will co-exist in some cases. This is owing to a chronic superficial infection of intertriginous areas of the skin caused by Corynebacterium minutissimum. Erythrasma
Small, red-brown macules that may coalesce into sharply demarcated larger patches with sharp borders will co-exist in some cases. This is owing to a chronic superficial infection of intertriginous areas of the skin caused by Corynebacterium minutissimum.
Satellite lesions Intertrigo complicated with candida infections manifest as satellite papules and pustules. Satellite lesions
Intertrigo complicated with candida infections manifest as satellite papules and pustules.

Investigations - Diagnosis

Fact Explanation
Wood lamp examination Wood's light is an ultraviolet light used to accentuate pigmentary changes in skin. It may help in identifying may identify a co-existing Pseudomonas infection by green fluorescence or erythrasma by coral-red fluorescence characterized to those conditions. Wood lamp examination
Wood's light is an ultraviolet light used to accentuate pigmentary changes in skin. It may help in identifying may identify a co-existing Pseudomonas infection by green fluorescence or erythrasma by coral-red fluorescence characterized to those conditions.
A scraping for mycology Skin scraping are taken and prepared with potassium hydroxide preparation for microscopical examination. This is mostly to exclude fungal diseases that may complicate intertrigo. Hyphae should be apparent with dermatophytes, whereas pseudohyphae should appear if candidiasis is present. A scraping for mycology
Skin scraping are taken and prepared with potassium hydroxide preparation for microscopical examination. This is mostly to exclude fungal diseases that may complicate intertrigo. Hyphae should be apparent with dermatophytes, whereas pseudohyphae should appear if candidiasis is present.
Blood culture Culture with sensitivities should be performed if secondary bacterial infections are suspected. Blood culture
Culture with sensitivities should be performed if secondary bacterial infections are suspected.
Fasting blood sugar This is done in patients who do not respond to optimal treatment as undiagnosed or uncontrolled diabetes mellitus can results in such situations. Fasting blood sugar
This is done in patients who do not respond to optimal treatment as undiagnosed or uncontrolled diabetes mellitus can results in such situations.

Management - Supportive

Fact Explanation
Prevention Making the environment unfavorable to develop intertrigo is the best way in prevention. Skin to skin friction should be minimized. The high risk areas such as axillae and groin should be kept dry and clean. The heat and moisture around the skin folds should be reduced. Though physical exercise usually is desirable the high risk areas should be dried thoroughly after a shower. Open-toed shoes may prevent toe web intertrigo. Obese patients should lose weight, if possible. Patients should wear light, nonconstricting, and absorbent clothing and should avoid nylon and other synthetic fibers. Prevention
Making the environment unfavorable to develop intertrigo is the best way in prevention. Skin to skin friction should be minimized. The high risk areas such as axillae and groin should be kept dry and clean. The heat and moisture around the skin folds should be reduced. Though physical exercise usually is desirable the high risk areas should be dried thoroughly after a shower. Open-toed shoes may prevent toe web intertrigo. Obese patients should lose weight, if possible. Patients should wear light, nonconstricting, and absorbent clothing and should avoid nylon and other synthetic fibers.

Management - Specific

Fact Explanation
Antiperspirant Antiperspirants are chemical agents that reduce perspiration or sweating. The active ingredients of roll-on and spray formulations are traditionally the metallic salts aluminium chloride and aluminium chlorohydrate. Aluminium-based complexes react with the electrolytes in the sweat to form a gel plug in the duct of the sweat gland. Sweating may be reduced with a gentle antiperspirants that helps in keeping the skin folds dry. Antiperspirant
Antiperspirants are chemical agents that reduce perspiration or sweating. The active ingredients of roll-on and spray formulations are traditionally the metallic salts aluminium chloride and aluminium chlorohydrate. Aluminium-based complexes react with the electrolytes in the sweat to form a gel plug in the duct of the sweat gland. Sweating may be reduced with a gentle antiperspirants that helps in keeping the skin folds dry.
Antibiotics This is needed when intertrigo is complicated with secondary bacterial infection. Bacteria may be treated with topical antibiotics such as fusidic acid cream, mupirocin ointment, or oral antibiotics such as flucloxacillin and erythromycin. Antibiotics
This is needed when intertrigo is complicated with secondary bacterial infection. Bacteria may be treated with topical antibiotics such as fusidic acid cream, mupirocin ointment, or oral antibiotics such as flucloxacillin and erythromycin.
Antifungals Yeasts and fungi may be treated with topical antifungals such as clotrimazole and terbinafine cream or oral agents such as itraconazole or terbinafine. Antifungals
Yeasts and fungi may be treated with topical antifungals such as clotrimazole and terbinafine cream or oral agents such as itraconazole or terbinafine.
Steroids Topical mild steroids such as hydrocortisone are used in cases of predominant inflammation. It decreases inflammation by suppression of macrophage and leukocyte migration. Steroids
Topical mild steroids such as hydrocortisone are used in cases of predominant inflammation. It decreases inflammation by suppression of macrophage and leukocyte migration.
Topical calcineurin inhibitors Topical calcineurin inhibitors such as pimecrolimus and tacrolimus are effective in refractory cases. They are thought to inhibits T-lymphocyte activation and there by suppress inflammation. These drugs are available as creams or ointments. Topical calcineurin inhibitors
Topical calcineurin inhibitors such as pimecrolimus and tacrolimus are effective in refractory cases. They are thought to inhibits T-lymphocyte activation and there by suppress inflammation. These drugs are available as creams or ointments.

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