Candidal Intertrigo Treatment

Candida Intertrigo (Candidiasis of Large Skinfolds)

Pink to red maceration, occurring where two skin folds come together.
Warm moist environment leads to disruption of the skin barrier, predisposing to yeast infection.

Predisposing factors include obesity, immunodeficiency (e.g. diabetes, prednisone), hot humid weather, poor hygiene, tight-fitting clothing, and use of topical steroids.

Red moist, glistening plaques with satellite pustules and papules with a fringe of white scale.
Painful fissures frequently occur deep within the skin folds.

Potassium hydroxide wet mount preparation from a pustule or scaly border shows spores and pseudohyphae.
Skin biopsy and a surface culture may be necessary in treatment-resistant cases.

Candida intertrigo usually recurs if the underlying conditions are not corrected.

Apply wet dressings (tap water or Burow’s solution [aluminum acetate 1 : 40 solution]) with a soft cotton cloth for 20 minutes several times per day to soothe and dry the area.
Application of an antiyeast cream (e.g. nystatin) or an antifungal (e.g. econazole) cream should be applied twice daily in a thin layer.
Oral antifungal agents (e.g. fluconazole 100–200 mg per day for 1 week) treat resistant or severe cases.
Sealing in the skin with a light moisturizer (e.g. Vanicream Lite or Lubriderm) may prevent recurrences by decreasing friction and acting as a protective barrier.
Powders may be helpful to wick away moisture but may clump if there is excessive moisture.
Patients should be encouraged to lose weight and avoid tight-fitting clothing.

Nystatin is not effective for dermatophyte infections, and griseofulvin and terbinafine are not effective for yeast infections.
Consider streptococcal infection if the rash is painful and malodorous.
Topical corticosteroid use may predispose to yeast and dermatophyte infection.
Patients who do not respond to antiyeast medications may have inverse psoriasis.