Intertrigo: Symptoms, Types, Causes and Treatment

Intertrigo is a common skin condition that affects people of all ages and backgrounds. Characterized by inflammation of skin folds, it can significantly impact comfort and quality of life, especially in those with underlying risk factors. This article will guide you through the symptoms, types, causes, and evidence-based treatment strategies for intertrigo, using the latest scientific findings.

Symptoms of Intertrigo

Intertrigo reveals itself through a range of visible and sensory symptoms, most often developing in areas where skin touches skin. These symptoms can vary in intensity, sometimes causing only mild irritation, but in other cases leading to severe discomfort and even secondary infections. Recognizing the main symptoms early is crucial for prompt and effective management.

Symptom	Description	Common Areas	Source
Erythema	Redness of the skin	Skin folds, groin, feet, under breasts	1, 3, 4, 7, 8
Itching	Persistent itch or burning sensation	Groin, perianal, large folds	2, 3, 8, 11
Maceration	Softening/whitening of skin due to moisture	Toe webs, under breasts, abdominal folds	1, 4, 6, 7
Exudation	Oozing or moist discharge (sometimes malodorous)	Interdigital spaces, deeper folds	1, 4
Scaling	Flaky or peeling edges	Skin folds, groin	7
Pain/Burning	Sensation of pain or stinging	Affected folds, especially with infection	1, 2, 8
Satellite Lesions	Small red bumps or pustules near main rash	Candida-infected areas	7, 8

Table 1: Key Symptoms

Common Presentations

Intertrigo typically begins with redness (erythema) and irritation in skin folds, where friction and moisture accumulate. As the condition progresses, the skin may appear macerated—soft, white, and wrinkled due to prolonged dampness. Oozing or exudate—sometimes foul-smelling—can develop, particularly when secondary infection sets in 1, 4.

Sensory Symptoms

People often report itching, which may escalate to burning or pain, especially when the skin breaks down or when infection is present 2, 3, 8. In candidal intertrigo, satellite lesions—small red bumps or pustules surrounding the main rash—are a notable feature 7, 8.

Other Features

• Scaling at the periphery is common, especially in chronic or fungal cases 7.
• In severe cases, erosions or open sores may develop, raising the risk of further infection 1, 4.
• The extent and severity of symptoms often depend on the underlying cause and patient factors such as obesity, diabetes, or immunosuppression 8, 9.

Types of Intertrigo

Intertrigo is not a one-size-fits-all condition. Its types are defined by location, underlying cause, and the specific microorganisms involved. Understanding these variations is essential for accurate diagnosis and tailored treatment.

Type	Defining Features	Typical Sites	Source
Candidal	Red, moist rash with satellite lesions	Groin, under breasts, armpits, perianal	7, 8
Bacterial	Erythematous, often malodorous, may erode	Toe webs, groin, large folds	1, 5, 7
Dermatophytic	Scaly, red edges, more dry than moist	Groin, feet, between toes	3
Erythrasma	Brownish-red, well-defined, minimal scaling	Groin, armpits, toe webs	3, 7
Trichosporosis	Itching, burning, fungal overgrowth	Genitocrural, perianal	2
Mechanical	Redness due to friction/moisture, no infection	Under breasts, abdominal folds	4, 6, 9

Table 2: Intertrigo Types

Candidal Intertrigo

Candida species, especially Candida albicans, thrive in warm, moist environments, leading to a red, moist rash with characteristic satellite lesions. This type is most common in individuals with diabetes, obesity, or immunosuppression and typically affects large skin folds—such as under the breasts or in the groin 7, 8.

Bacterial Intertrigo

Bacterial forms are often due to Streptococcus pyogenes, Staphylococcus aureus, or Gram-negative bacteria like Pseudomonas aeruginosa. These can present as bright red, sharply demarcated lesions (streptococcal), or as macerated, malodorous, sometimes erosive rashes (Pseudomonas, mixed Gram-negative infections) 1, 5. Secondary bacterial infection can complicate any form of intertrigo 7.

Dermatophytic Intertrigo

Dermatophytes (fungi causing tinea) are a leading cause in some regions and commonly affect the groin (tinea cruris) or toe web spaces (tinea pedis). These forms tend to have a dry, scaly border, and may be less moist than candidal or bacterial types 3.

Erythrasma

Caused by Corynebacterium minutissimum, erythrasma mimics fungal intertrigo but is typically brownish-red with minimal scaling. It is best detected using a Wood’s lamp, which highlights coral-red fluorescence 3, 7.

Trichosporosis

This rare variant is due to Trichosporon beigelii and is most prevalent in tropical regions. It usually affects the genitocrural and perianal areas, causing itching and burning 2.

Mechanical (Non-Infectious) Intertrigo

Some intertrigo is purely mechanical or irritant in nature, caused by friction and moisture alone, without overt infection. However, these cases are at high risk for secondary microbial invasion 4, 6, 9.

Causes of Intertrigo

Understanding what triggers intertrigo is vital for both prevention and management. Causes can be broadly categorized into environmental/physical factors and biological agents, often working together to create the perfect storm for skin breakdown.

Cause	Mechanism/Contributing Factors	Risk Groups	Source
Moisture	Sweat, urine, feces, body secretions	Obese, infants, elderly	4, 6, 7, 9
Friction	Skin-on-skin contact in folds	Overweight, large breasts, athletes	6, 9
Poor Ventilation	Occluded/folded skin retains heat	Care-dependent, bedbound	7, 9
Microorganisms	Fungi (Candida, dermatophytes), Bacteria (Strep, Corynebacterium, Pseudomonas)	Immunosuppressed, diabetics	1, 3, 5, 7, 8
Systemic Disease	Diabetes, immunosuppression	Diabetics, transplant patients	8, 9
Hygiene	Insufficient cleaning/drying of folds	Care-dependent, elderly	9

Table 3: Causes and Risk Factors

Physical and Environmental Triggers

At its core, intertrigo is a disease of moisture and friction. When skin surfaces rub together in a warm, damp environment—like under the breasts, in the groin, or between toes—the protective barrier breaks down 4, 6, 7. This makes the area susceptible to irritation and infection.

Microbial Overgrowth

Fungi (Candida, dermatophytes) and bacteria (Streptococcus, Corynebacterium, Pseudomonas) seize the opportunity to invade compromised skin. In many cases, infections are polymicrobial, meaning more than one microorganism is present, making treatment more complex 1, 3, 7, 8.

Predisposing Medical Conditions

Some people are more vulnerable:

• Obesity increases skin folds and sweating 9.
• Diabetes alters immune response and skin integrity 8, 9.
• Immunosuppression—from medications or diseases—reduces the body's ability to keep microbes in check 8.
• Age and Dependency: Elderly individuals and those requiring assistance with hygiene are at greater risk 9.

Hygiene and Lifestyle

Poor hygiene, infrequent changing of clothing, and inadequate drying of skin after bathing or exercise can all contribute. Wearing tight, synthetic clothing or non-breathable shoes can also trap moisture and heat, worsening the risk 6, 9.

Treatment of Intertrigo

Managing intertrigo requires a multifaceted approach: addressing the underlying physical factors, treating any infection, and preventing recurrence. While the core principles are clear, there are many options for both prevention and therapy.

Treatment	Description/Method	Suitability/Notes	Source
Barrier Creams	Zinc oxide, honey-based creams	First-line for moisture control	6, 11
Topical Antifungals	Nystatin, clotrimazole, ketoconazole	For candidal/fungal cases	7, 8
Topical Antibiotics	Mupirocin, fusidic acid	For bacterial superinfection	5, 7
Systemic Therapy	Oral antibiotics/antifungals	Severe, recurrent, resistant cases	1, 7, 8
General Care	Keeping area dry, loose clothing, hygiene	Universal	6, 8, 9
Surgical Options	Reduction mammaplasty (rare)	Intractable inframammary cases	10

Table 4: Main Treatments

General Measures

The cornerstone of intertrigo management is moisture control:

• Use of barrier creams (zinc oxide, honey-based) to protect skin—both have been shown effective, with honey cream offering some advantage in itch reduction 11.
• Keeping skin folds dry: frequent drying, use of absorbent powders (e.g., cornstarch), and wearing loose, breathable clothing 6, 8.
• Improving hygiene: gentle cleaning and thorough drying after washing, especially after exercise or heavy sweating 6, 9.

Targeted Medical Therapy

Fungal Infections

For candidal or dermatophyte intertrigo:

• Topical antifungals such as nystatin, clotrimazole, ketoconazole, and others are standard. Refractory cases may require oral therapy (e.g., fluconazole) 7, 8.
• Trichosporosis and other rare fungal forms are treated similarly, with specific antifungals as indicated 2.

Bacterial Infections

For secondary bacterial infections:

• Topical antibiotics (mupirocin for streptococcal, erythromycin for Corynebacterium) are used 5, 7.
• Severe or resistant bacterial intertrigo, especially those involving Gram-negative bacteria, may need systemic antibiotics, guided by culture and sensitivity testing to avoid resistance 1.

Erythrasma

This bacterial type responds well to oral erythromycin or topical antibiotics, with diagnosis confirmed via Wood’s lamp 7.

Addressing Underlying Conditions

• Weight loss and improved management of diabetes have a significant impact in reducing recurrence 8, 9.
• In cases resistant to medical therapy, especially with anatomical factors like large breasts, surgical intervention (e.g., reduction mammaplasty) may be considered, though evidence is limited 10.

Prevention

Despite the abundance of interventions, firm evidence for prevention strategies is lacking. However, experts agree that consistent skin care routines—keeping folds dry, minimizing friction, and attending to underlying conditions—are key 6, 9, 10.

Conclusion

Intertrigo is a multifaceted skin condition that thrives where warmth, moisture, and friction combine—especially in those with underlying risk factors. Recognizing its symptoms, understanding the types and causes, and implementing tailored, evidence-based treatments are crucial for improving comfort and preventing complications.

Key Points:

• Intertrigo manifests as red, itchy, and sometimes painful rashes in skin folds, often with maceration and exudate.
• Types include candidal, bacterial, dermatophytic, erythrasma, trichosporosis, and non-infectious (mechanical) intertrigo, each with distinct features.
• Causes are rooted in moisture, friction, poor ventilation, and microbial overgrowth, with obesity, diabetes, and poor hygiene being major risk factors.
• Treatments focus on moisture control, barrier creams, antifungal or antibiotic therapy as appropriate, and addressing underlying health issues.
• Consistent hygiene, keeping folds dry, and managing systemic diseases are essential for both treatment and prevention.

With a comprehensive, individualized approach, intertrigo can be effectively managed, improving both skin health and overall quality of life.