What are the common causes of intertrigo. How can you identify the symptoms of this skin condition. What are the most effective treatments for intertrigo. How can you prevent skin fold infections from occurring.

Understanding Intertrigo: A Common Skin Fold Infection

Intertrigo is a skin condition that occurs when folds of skin rub against each other, creating an environment conducive to irritation and potential infection. This condition primarily affects areas where skin-to-skin contact is frequent, such as the inner thighs, armpits, under the breasts, and in abdominal folds. The warm, moist environment in these areas can lead to the growth of yeast and bacteria, exacerbating the condition.

Who is most susceptible to intertrigo? While it can affect individuals of any age, certain groups are at higher risk:

• Infants (often presenting as diaper rash)
• Older adults
• People with limited mobility
• Individuals with obesity
• Those with diabetes
• People with a weakened immune system

Environmental factors also play a role in the development of intertrigo. The condition is more prevalent in hot or humid climates and tends to occur more frequently during summer months.

Recognizing the Symptoms of Intertrigo

How can you identify intertrigo? The primary symptoms include:

• A red, raw-looking rash in skin folds
• Soreness or itching in the affected area
• Possible oozing from the rash

Where does intertrigo typically develop? Common areas include:

1. Inner thighs
2. Under the breasts
3. In the fold beneath a protruding belly
4. The groin area
5. Between the buttocks
6. In the webs of fingers and toes

It’s important to note that intertrigo can occur in one or multiple areas simultaneously.

Underlying Health Conditions Associated with Intertrigo

While intertrigo can occur in otherwise healthy individuals, certain health conditions can increase the likelihood of developing this skin issue. These include:

Inverse Psoriasis

Also known as intertriginous psoriasis, this condition manifests in skin folds and can appear red and shiny, similar to intertrigo.

Hailey-Hailey Disease

This rare genetic disorder affects skin cell adhesion and can cause blisters and irritations in areas prone to intertrigo, such as the neck, armpits, and genitals.

Pemphigus

An autoimmune condition that causes blistering on the skin and mucous membranes, pemphigus can sometimes be mistaken for intertrigo in its early stages.

Bullous Pemphigoid

Another autoimmune disorder, bullous pemphigoid causes itchy welts or blisters on the skin, often in areas that flex or move frequently.

Diagnosing Intertrigo: What to Expect

How is intertrigo diagnosed? Typically, a dermatologist will make the diagnosis through a combination of visual inspection and patient history. The process usually involves:

• A thorough examination of the affected skin areas
• Questions about symptoms and their duration
• Consideration of risk factors and medical history

In some cases, if a yeast or bacterial infection is suspected, the dermatologist may take a swab of the affected area for laboratory analysis. This helps determine the specific microorganism involved and guides treatment decisions.

Effective Treatment Strategies for Intertrigo

What are the most effective ways to treat intertrigo? Treatment typically focuses on reducing moisture, friction, and microbial growth in the affected areas. Here’s a recommended treatment protocol:

1. Cleanse the area with ketoconazole 1% shampoo, leaving it on for 2-5 minutes before rinsing.
2. Dry the area thoroughly, using a hairdryer on a low setting if necessary.
3. Apply a mixture of equal parts clotrimazole 1% cream (or miconazole 1% cream) and hydrocortisone 1% cream twice daily.
4. Continue treatment for 3-8 weeks or until the rash clears.

After the rash has resolved, maintain prevention by using ketoconazole 1% shampoo as a soap in the affected area at least once a week, and ensure thorough drying after bathing or whenever the area becomes damp.

Preventing Intertrigo: Key Strategies for Skin Health

How can you prevent intertrigo from occurring or recurring? The American Osteopathic College of Dermatology recommends several preventive measures:

• Keep skin folds dry by placing absorbent material, such as cotton, in the affected areas
• Use antiperspirants to reduce sweating
• Wash daily with an antibacterial soap
• Apply an absorbent antifungal powder to clean, dry skin in prone areas

For individuals who experience recurrent intertrigo due to obesity, consulting with a healthcare provider about weight management strategies can be beneficial in reducing the risk of skin complications.

When to Seek Medical Attention for Intertrigo

While many cases of intertrigo can be managed at home, when should you consult a healthcare professional? Consider seeking medical attention if:

• The rash persists despite home treatment
• You experience frequent recurrences of intertrigo
• The affected area becomes increasingly painful or shows signs of infection
• You have an underlying health condition that may complicate treatment

A dermatologist can provide more targeted treatment options and help identify any underlying factors contributing to persistent intertrigo.

Lifestyle Modifications to Manage Intertrigo

Beyond medical treatments, what lifestyle changes can help manage intertrigo? Consider implementing the following strategies:

• Wear loose-fitting, breathable clothing to reduce friction and moisture in skin folds
• Change out of wet or sweaty clothes promptly
• Use moisture-wicking fabrics during exercise or in hot weather
• Maintain good overall hygiene, paying special attention to prone areas
• Manage underlying health conditions, such as diabetes, that may increase your risk

These lifestyle modifications, combined with proper skincare and preventive measures, can significantly reduce the occurrence and severity of intertrigo.

Understanding intertrigo and its management is crucial for maintaining skin health, especially for those at higher risk. By recognizing the symptoms early, implementing effective treatment strategies, and adopting preventive measures, individuals can minimize the impact of this common skin condition on their daily lives. Remember, persistent or severe cases warrant professional medical attention to ensure proper care and prevent complications.

Causes, symptoms, pictures, and treatment

Intertrigo is a skin condition that causes a rash in skin folds, such as under the breasts, in the groin, or in stomach folds. The rash may be sore or itchy.

It happens when areas of moist skin rub together. Bacteria and yeast can grow in this environment, leading to an infection.

In this article, we describe what intertrigo is, what it looks like, and what causes it. We also cover diagnosis, treatment, and prevention.

Intertrigo is a skin condition that happens when folds of skin chafe against each other.

It usually develops in the inner thighs or armpits, or under the breasts or tummy fold.

Some people may experience yeast or bacterial infections in the folds of skin.

Areas of moist skin rubbing together cause intertrigo. The warm, damp environment makes the skin conducive to irritation and the growth of yeast and bacteria, which can lead to an infection.

While it can happen at any age, intertrigo tends to affect infants, older people, and those with a reduced ability to move around. In babies, it is often called diaper rash. Most cases occur in hot or humid environments and during the summer.

Intertrigo is also more common in adults with incontinence, obesity, diabetes, or a weakened immune system.

Specific health conditions that can contribute to the development of intertrigo include:

Inverse psoriasis

Also known as intertriginous psoriasis, this form of psoriasis develops in the folds of the skin. It can look red and shiny.

Hailey-Hailey disease

Hailey-Hailey disease is a rare genetic disorder that causes skin cells to stick together and breaks down the layers of the skin.

People with Hailey-Hailey disease usually experience blisters and irritations on the neck, armpits, and genitals and in the folds of the skin.

Pemphigus

There are different types of pemphigus, but they all happen when the body’s immune system attacks the healthy cells in the top layer of the skin.

It typically causes blisters in the mouth, nose, throat, eyes, or genitals.

Bullous pemphigoid

A fault in the immune system causes bullous pemphigoid. People with the condition can develop mild, itchy welts or more severe blisters on the skin. These tend to appear on areas of the skin that flex or move.

Intertrigo looks like a red, raw rash on the skin. It may feel sore or itchy, and it can sometimes ooze.

It can develop in any fold of the skin. The most commonly affected areas of the body include:

• the inner thighs
• under the breasts
• in the fold of skin underneath a protruding belly
• the groin
• between the buttocks
• in the webs of the fingers
• in the webs of the toes

Intertrigo may develop in one or more of these places.

It will often be a specialist skin doctor, or dermatologist, who diagnoses intertrigo. They will do this by inspecting the skin and asking a series of questions about the person’s symptoms.

If the dermatologist suspects that a yeast or bacterial infection has developed in the skin fold, they may take a swab and send it to a laboratory for analysis.

An article in the Journal of the Dermatology Nurses’ Association offers the following advice on treating intertrigo:

• Wash the affected area with ketoconazole 1% shampoo, which is available from most drugstores. People should leave it on for 2–5 minutes and then rinse it off.
• Use a hairdryer on a low setting to ensure that the area is completely dry.
• Mix equal amounts of clotrimazole 1% cream (or miconazole 1% cream) and hydrocortisone 1% cream and apply a thin layer to the affected area. People should do this twice a day until the rash is clear, which may take 3–8 weeks.
• Once the rash has cleared, continue to use the ketoconazole 1% shampoo as soap in the affected area at least once a week.
• Dry the skin with a hairdryer after every bath or shower, or whenever it feels particularly damp.

The best way to prevent intertrigo is to keep the area dry. People who experience the condition due to obesity can speak to a doctor about ways to lose weight and reduce the risk of skin complications.

The American Osteopathic College of Dermatology suggest that people prevent intertrigo by:

• placing a wad of absorbent material, such as cotton, in the affected fold to absorb sweat
• using antiperspirants
• washing daily with an antibacterial soap
• dusting the affected area with an absorbent antifungal powder once it is clean and dry

Anyone who finds that the problem keeps coming back should speak to a doctor.

Intertrigo is a skin condition that happens when areas of moist skin rub against each other. It causes a red, raw-looking rash and can lead to yeast and bacterial infections.

It can happen to anyone, but it is most common in babies, older people, individuals with mobility problems, and those with obesity.

People can easily treat the rash at home with over-the-counter creams and lotions. They can also prevent it from coming back by keeping the area clean and dry.

Anyone who experiences multiple incidences of intertrigo should speak to a doctor.

Intertrigo – StatPearls – NCBI Bookshelf

Continuing Education Activity

Intertrigo is a superficial inflammatory skin condition of the skin’s flexural surfaces, prompted or irritated by warm temperatures, friction, moisture, maceration, and poor ventilation. Intertrigo’s Latin translation, inter (between) and terere (to rub) helps explain the physiology of the condition. Intertrigo commonly becomes secondarily infected, notably with Candida; however, other viral or bacterial etiologies may play a factor in its pathogenesis. This activity reviews the presentation of intertrigo and highlights the role of the interprofessional team in its management.

Objectives:

• Review the etiology of intertrigo.

• Describe the presentation of intertrigo.

• Summarize the treatment of intertrigo.

• Explain modalities to improve care coordination among interprofessional team members in order to improve outcomes for patients affected by intertrigo.

Access free multiple choice questions on this topic.

Introduction

Intertrigo is a superficial inflammatory skin condition of the skin’s flexural surfaces, prompted or irritated by warm temperatures, friction, moisture, maceration, and poor ventilation. Intertrigo’s Latin translation, inter (between), and terere (to rub) helps explain the physiology of the condition.[1] Intertrigo commonly becomes secondarily infected, notably with Candida; however, other viral or bacterial etiologies may play a factor in its pathogenesis. Intertrigo can be seen in all ages and is primarily a clinical diagnosis, with the frequently affected areas being the axilla, inframammary creases, abdominal folds, and perineum. Characteristically, the lesions are erythematous patches of various intensity with secondary lesions appearing as the condition progresses or is manipulated.[2]

Etiology

Mechanical factors and secondary infections are the landscape causes of intertrigo. Heat with maceration plays a central role in facilitating this process. The skin folds battle constant frictional forces producing irritation and, at times, erosions to the inflamed skin. Further, moisture builds up in the affected intertriginous areas and develops a feeding ground for secondary infection to flourish. Candida species thrive in heated, high-moisture environments and are a common offender of secondary infection in cases of intertrigo. Moreover, patients with diabetes mellitus have increased pH levels in intertriginous areas contributing to their demographic prevalence.[3] However, it is not uncommon to see gram-positive and gram-negative bacteria, as well as other fungi and viruses accounting for some of the cases of secondary infection.[4][5][6]

Epidemiology

People of all ages, from infancy through advanced age, can be affected by intertrigo. The inflammatory condition manifests itself in the infantile age group as a variation of diaper dermatitis. Furthermore, the increased likelihood of a naive or reduced immune system, lack of mobility, and urinary/bowel incontinence contributes to the skin manifestations and their complications. [2] Obesity and diabetes mellitus are two conditions that increase the frequency of developing intertrigo.[5] The condition is most prevalent in geographic areas that have hot and humid climates. Lastly, there is no race or gender predilection observed with the condition.

Pathophysiology

Environmental factors and genetic causes play a leading role in the development of intertrigo. One of these factors is the friction caused by adjacent skin surfaces causing inflammation of the epidermis. Moreover, flexural surfaces have a higher surface temperature compared to other body parts. The moisture and sweat build-up that gets trapped in these areas adds to the maceration of the stratum corneum and epidermis. Additionally, the integumentary system houses bacteria and yeast that flourish in this environment and overgrow in these conditions, making infection a common finding.[4][5][6]

Histopathology

There is no characteristic histologic change seen in intertrigo. Some cases can present with mild spongiosis visualized in the epidermis.

History and Physical

The presentation of intertrigo is generally a chronic subtle onset of pruritus, burning, tingling, and pain in the skin folds and flexural surfaces. If there is an acute change in the quality of the symptoms, consider a secondary infection with Candida albicans, bacteria, or other pathologic organisms. Likely, the patient will be involved in an activity that involves rubbing of their skin surfaces together. Hot and humid environmental conditions are also aggravating factors that contribute to the pathology. Therefore, intertrigo tends to see a higher rate of seasonal incidence. Hyperhidrosis, seen with strenuous exercise, is a prominent contributing factor in the inflammatory condition. Predisposing factors such as obesity and diabetes mellitus, as well as signs of incontinence, urethral discharge, and draining wounds on the exam all contribute to the warm, moist occluded environment responsible for the development of intertrigo.[7]

On physical examination, prevalence is highest among obese patients, yet all body mass index (BMI) subclasses can be affected dependent on other factors. The increased surface area in obese patients accentuates the folds and creases of the body suitable for higher body temperatures. The initial presentation on the skin exam is a mildly erythematous patch on both sides of the skin fold. The degree of inflammation is dependent upon factors such as location and duration, as well as if there is a secondary infection. Over time, the erythematous patch can develop erosions, macerations, fissures, crust, and weeping from the site. If a pustule, crust, or vesicle is visible, a secondary infection should be considered. If Candida species are suspected, satellite papules and pustules are pathognomic. A bluish-green tint can indicate infection with Pseudomonas.[8] Bacterial intertrigo tends to weep and is an intensely erythematous and a potentially tender lesion.[4] In interdigital intertrigo, Trichophyton rubrum, Trichophyton mentagrophytes, and Epidermophyton floccosum are the implicated organisms in this body region. [9]

Evaluation

Further evaluation beyond the clinical diagnosis may be required to determine the exact cause and most effective treatment modality. The lesion can be cultured if a bacterial infection is suspected. Fungus, another common invader, can be elicited by a skin scraping of the lesion. The scraping should be taken from the active margin of a lesion, and a 20% potassium hydroxide (KOH) solution is added. The presence of hyphae and/or budding yeast, when viewed with light microscopy, indicates a fungal infection. If the presentation is unusual or therapy has failed, consider performing a biopsy. The use of a Wood lamp can help detect Pseudomonas or erythrasma (Corynebacterium minutissimum) infections. A fasting blood glucose level should be obtained if there is suspicion of diabetes mellitus. This is especially true with difficult to treat and recurrent episodes.

Treatment / Management

To properly treat intertrigo, it is imperative to recognize the underlying factor that is causing the condition. Therefore, the offending causative factor or agent discussed above should be reduced or removed. If there is an infectious component to the rash, then the proper antimicrobial medication should be administered. In simple intertrigo, drying agents such as antiperspirants can be used to minimize the moisture. A bath or shower with proper drying using a soft towel should follow physical activity that causes excessive perspiration. Triple paste, comprised of aluminum acetate solution, zinc oxide, and petrolatum, is an effective antiperspirant that also reduces frictional exposure and improves skin irritation. Staying cool by wearing loose clothing and working in air-conditioned environments will help in the prevention of the rash. Absorbent powders compressed with an aqueous solution of aluminum triacetate 1:40, and wet tea bags are other preventative measures that have been proven to be effective. Absorbent diapers are more effective at decreasing moisture; however, if treatment is required, petrolatum ointment or cream is effective and safe for diaper dermatitis. If the lesion is infected with a bacteria and is mild, then a topical treatment such as mupirocin or bacitracin can be used. If oral medication is required, an effective option against gram-positive bacteria, notably Staphylococcus or Streptococcus, like flucloxacillin or erythromycin, should be prescribed. Topical clotrimazole, ketoconazole, and oxiconazole are effective treatment options for yeast or fungal infected intertrigo. Topical nystatin is effective only for candidal intertrigo. Topical treatments are applied twice a day until the rash resolves. Oral fluconazole 100 to 200 mg daily for seven days can be used for resistant fungal infections. Low-dose steroids may be initiated for anti-inflammatory properties, for example, hydrocortisone cream, yet it is not always needed. A lower strength steroid is preferred if chosen to prevent atrophy in the already thinner epidermis of the flexural surfaces.[10][11]

Differential Diagnosis

The differential is quite extensive for intertrigo. Many other conditions present in the flexural surfaces. However, infection is most important to rule out, and the proper infectious agent should be sought out to provide the correct antimicrobial therapy necessary to eliminate the offending agent. Bacteria, viruses, dermatophytes, and candidal organisms can all cause intertrigo or provoke a secondary infection.[12] Once an infection is ruled out, other similarly presenting conditions commonly found in the flexural surfaces can be further investigated. More common conditions such as seborrheic dermatitis, irritant or allergic contact dermatitis, atopic dermatitis, inverse psoriasis, pemphigus, scabies, metabolic derangements, and malignancies frequently present in the skin fold mimicking intertrigo.[13] Nonetheless, intertrigo remains a clinical diagnosis with the findings and clinical picture as previously described.

Prognosis

The prognosis is positive for the majority of patients. The underlying risk factors should be addressed to diminish the intertrigo outbreaks. However, if the risks such as diabetes mellitus and obesity are not properly managed, the condition tends to relapse quite frequently.

Complications

The complications that can arise with intertrigo are predominantly secondary infections that have been discussed at length above. To optimize the prevention of infection, the rash should be directed to a clinician to properly manage the condition. If left untreated, the rash can develop into cellulitis.[14] Furthermore, sepsis can result from hidden ulcers that develop in patients without supervision or obese individuals. Contact dermatitis can occur secondary to topical agents used to treat the rash. Also, prolonged steroid use can cause atrophy and striae to the thinned epidermis of the flexural surfaces.

Consultations

Whether it is the pediatrician or primary care clinician, if there is a doubt of the diagnosis or a rash that has failed treatment, a dermatologist should be consulted to manage the condition further.

Deterrence and Patient Education

Topics that should be discussed with the patient and their family is weight loss and weight control, proper hygiene, glycemic control in patients who have diabetes mellitus, and measures to reduce the frictional component of skin-to-skin contact.

Pearls and Other Issues

Often, there is a combination of an infectious and inflammatory component. To delineate the two, infections are often unilateral and asymmetrical. Inflammatory disorders tend to be symmetrical the majority of the time.

Enhancing Healthcare Team Outcomes

Patients with intertrigo are best managed by an interprofessional team approach. Clinicians, nurses, and pharmacists all play an optimal role in achieving successful clearance of the rash. Clinicians and nurses need to emphasize and educate the preventative risk factors and management of the rash to clear the current and prevent further intertrigo occurrences. The clinician can consult the pharmacist when necessary to help with varying formulations of topical therapy as well as oral for certain infectious etiologies.

Review Questions

• Access free multiple choice questions on this topic.

• Comment on this article.

Figure

Candida Intertrigo. Contributed by DermNetNZ

References

1.

Wolf R, Oumeish OY, Parish LC. Intertriginous eruption. Clin Dermatol. 2011 Mar-Apr;29(2):173-9. [PubMed: 21396557]

2.

Kalra MG, Higgins KE, Kinney BS. Intertrigo and secondary skin infections. Am Fam Physician. 2014 Apr 01;89(7):569-73. [PubMed: 24695603]

3.

Yosipovitch G, Tur E, Cohen O, Rusecki Y. Skin surface pH in intertriginous areas in NIDDM patients. Possible correlation to candidal intertrigo. Diabetes Care. 1993 Apr;16(4):560-3. [PubMed: 8462378]

4.

Chiriac A, Murgu A, Coroș MF, Naznean A, Podoleanu C, Stolnicu S. Intertrigo Caused by Streptococcus pyogenes. J Pediatr. 2017 May;184:230-231.e1. [PubMed: 28237374]

5.

Metin A, Dilek N, Bilgili SG. Recurrent candidal intertrigo: challenges and solutions. Clin Cosmet Investig Dermatol. 2018;11:175-185. [PMC free article: PMC5909782] [PubMed: 29713190]

6.

Adışen E, Önder M. Viral infections of the folds (intertriginous areas). Clin Dermatol. 2015 Jul-Aug;33(4):429-36. [PubMed: 26051057]

7.

Ndiaye M, Taleb M, Diatta BA, Diop A, Diallo M, Diadie S, Seck NB, Diallo S, Ndiaye MT, Niang SO, Ly F, Kane A, Dieng MT. [Etiology of intertrigo in adults: A prospective study of 103 cases]. J Mycol Med. 2017 Mar;27(1):28-32. [PubMed: 27554869]

8.

Kalkan G, Duygu F, Bas Y. Greenish-blue staining of underclothing due to Pseudomonas aeruginosa infection of intertriginous dermatitis. J Pak Med Assoc. 2013 Sep;63(9):1192-4. [PubMed: 24601205]

9.

Grosshans E, Schwaab E, Samsoen M, Grange D, Koenig H, Kremer M. [Clinical aspects, epidemiology and economic impact of foot epidermomycosis in an industrial milieu]. Ann Dermatol Venereol. 1986;113(6-7):521-33. [PubMed: 2949683]

10.

Del Rosso JQ. Adult seborrheic dermatitis: a status report on practical topical management. J Clin Aesthet Dermatol. 2011 May;4(5):32-8. [PMC free article: PMC3100109] [PubMed: 21607192]

11.

Hoeger PH, Stark S, Jost G. Efficacy and safety of two different antifungal pastes in infants with diaper dermatitis: a randomized, controlled study. J Eur Acad Dermatol Venereol. 2010 Sep;24(9):1094-8. [PubMed: 20553355]

12.

Honig PJ, Frieden IJ, Kim HJ, Yan AC. Streptococcal intertrigo: an underrecognized condition in children. Pediatrics. 2003 Dec;112(6 Pt 1):1427-9. [PubMed: 14654624]

13.

Wilmer EN, Hatch RL. Resistant “candidal intertrigo”: could inverse psoriasis be the true culprit? J Am Board Fam Med. 2013 Mar-Apr;26(2):211-4. [PubMed: 23471936]

14.

Vanhooteghem O, Szepetiuk G, Paurobally D, Heureux F. Chronic interdigital dermatophytic infection: a common lesion associated with potentially severe consequences. Diabetes Res Clin Pract. 2011 Jan;91(1):23-5. [PubMed: 21035887]

Disclosure: Timothy Nobles declares no relevant financial relationships with ineligible companies.

Disclosure: Richard Miller declares no relevant financial relationships with ineligible companies.

diagnostics, clinic, rational external therapy

Large fold dermatosis (CLD) is a group of diseases united according to the principle of selective localization on the skin. This group includes dermatoses that have different etiology and pathogenesis, but have clinical similarities that create difficulties for timely diagnosis and choice of rational therapy.

Downstream, these dermatoses can be divided into acute and chronic, in some of them large folds are selectively affected, while in most cases such dermatoses can manifest as a combined lesion of various parts of the skin and mucous membranes.

DCS often occur with the loss of those personality traits that are characteristic of the localization of the process on smooth skin, scalp, mucous membranes, etc. , which creates a deceptive similarity in the clinical manifestations of skin diseases of various etiologies. The complexity of timely diagnosis is aggravated by the localization of the process in closed, sometimes difficult to access areas, false modesty of patients or inattentive examination by a doctor [1].

The skin of large folds has the following individual characteristics:

1. Constantly rubbed and macerated.

2. Hypersecretion of sweat glands increases the pH of the skin folds (the environment becomes alkaline), which affects the microbial flora, leading to the activation, primarily of opportunistic microorganisms [2].

3. Insufficient aeration creates the prerequisites for the transition of opportunistic flora into pathogenic (first of all, this applies to yeast infection, as well as pyogenic coccal flora). In this case, the greatest risk group is made up of patients with diabetes mellitus, patients suffering from impaired thyroid function, etc. [3].

4. The anatomical structure and functions of the sebaceous and sweat glands in large folds also differ in originality, depending on the need to create easier sliding, stretching of the contacting surfaces in order to avoid friction, dryness, and limitation of mobility.

5. Apocrine sweat glands of large folds have relatively short and wide ducts, and their glomeruli, additionally connected by fibrous structures, are deeply immersed in loose subcutaneous fat.

6. The architectonics of collagen and elastic fibers gives a greater ability to stretch the skin of the folds compared to other areas of the skin.

7. The sebaceous glands function with a lesser load, since here the glands have only 1-2 lobules, in contrast to the 3-lobed glands on the scalp, facial skin in the region of the tip of the nose and chin [4].

These factors increase desquamation, desquamation of the stratum corneum of the epidermis, on the one hand, thinning it and making it more elastic, on the other hand, exposing it and making it impossible to serve as a barrier to pathogenic microorganisms and harmful chemicals. It should be noted the influence of various chemicals with water- and fat-soluble properties. Mixing with sebum and sweat, changing their chemical composition, both with external contact and with the penetration of the allergen into the skin, chemicals create conditions for additional irritation of the skin of large folds, which is especially evident in allergic dermatitis, toxicoderma, eczema [5] .

The approach to the treatment of DCS makes it necessary to take into account the localization, etiology and nature of the course of the disease: a combination of edema, maceration with exudation in acute inflammatory processes, dryness, infiltration with possible cracking of the skin in the depth of the fold in the chronic course of dermatosis, easy accession of a secondary infection. All this forces doctors to use step by step external means of drying anti-inflammatory, epithelizing and softening action. At the same time, the appointment of various forms, control over their correct use, inconvenience associated with the use of products that color linen and clothes create difficulties for the doctor and patient.

Currently developed and widely used in external therapy corticosteroid preparations of the company “Schering-Plough” (USA): elocom and triderm in various dosage forms. The therapeutic efficacy and safety of these drugs are very high, and the list of dermatoses in which it is advisable to use these drugs is also diverse.

In this report, we have included dermatoses that differ from each other in etiology and pathogenesis, but with a similar clinical picture, therefore, external therapy with creams seems to be quite justified elokom and triderm .

Elokom contains mometasone furoate as an active ingredient, which is a synthetic corticosteroid with anti-inflammatory, antipruritic and vasoconstrictive properties. Mometasone furoate is one of the safest topical glucocorticosteroids (TGCS) with minimal systemic bioavailability (0.4% for cream and 0.7% for ointment). These qualities are due to the presence of a predominantly extragenomic mechanism of action in mometasone furoate. If the genomic effect that prevails in most other TGCS is the formation of a glucocorticoid-glucocorticoid receptor complex, which in turn activates the expression of genes responsible for the synthesis of anti-inflammatory antigens, then the extra-genomic mechanism recently discovered by researchers includes direct inhibition of pro-inflammatory transcription factors by glucocorticoid-glucocorticoid receptor complexes. antigens. At the same time, the anti-inflammatory effect develops faster, and the effect on the genome is minimized, which determines the high safety profile of the drug elokom .

Triderm contains betamethasone dipropionate TGCS 0.05%, antibiotic gentamicin sulfate 0.1% and clotrimazole 1% as an antimycotic substance. It should be noted that clotrimazole, in addition to its own antifungal action, is able to have an antimicrobial effect against a number of microorganisms, allowing potentiating the action of gentamicin.

Simple contact dermatitis due to physical factors such as friction, pressure, less commonly obligate chemicals is very common. Dermatitis can occur in children, especially at an early age as a variant of diaper rash or the so-called diaper dermatitis. Clinically, the disease manifests itself as a bright inflammatory erythema with clear boundaries, less often with the addition of an exudative component in the form of edema and maceration. A particularly important factor is that powders, water- and oil-shaken creams, which were previously used to treat such manifestations, have now lost their value. Now, after using cream 9 for 2-3 days0029 elokom (a topical steroid approved for use without age restrictions), inflammatory changes can be quickly extinguished and relapses can be avoided if the necessary hygiene measures are observed.

Allergic DKS, which occurs more often under the action of facultative irritants of a chemical nature (cosmetics and perfumes, household chemicals, etc.), is usually accompanied by a clinical picture that is much more pronounced in severity compared to that in dermatosis of other areas of the skin. Erythema, edema, vesiculation in allergic dermatitis, similar to an eczematous process or drug-induced toxicoderma, form a torpid course of the disease when localized in large folds (Fig. 1). Figure 1. Dermatitis. The clinical picture of these dermatoses is dominated by polymorphic rashes grouped into foci without clear boundaries, often spreading to areas remote from the place of contact with the allergen [6]. General desensitizing therapy gives a relatively quick resolution of the process on smooth skin, while in large folds the rash fades more slowly, which is associated with the above features of these zones. In this case, external therapy using cream elokom will be justified and effective. Often, the chronization of the process in microbial, less often true eczema, especially when the affected area is the inguinal-femoral, perianal, and in men the inguinal-scrotal folds, makes it necessary to use cream triderm to prevent the attachment of a secondary infection (microbial and yeast). The combination of antimycotic, antimicrobial and anti-inflammatory effects creates a high therapeutic activity to stop these appearances in a short time, restoring health and aesthetic comfort to patients.

Lesions of large folds by yeast fungi have a rather diverse clinical picture. Arising on the skin under the mammary glands, under the abdomen, in the umbilical and inguinal folds, lesions caused by fungi of the genus Candida and others can manifest as diffuse erythema, micropapular and microvesicular elements. In the latter case, along the periphery of the focus, as a result of the fusion of individual microvesicular elements and their opening, a finely scalloped edge of the exfoliated epidermis is formed, extending beyond the fold, onto smooth skin, and in the depth of the fold, one can see a whitish cheesy plaque as a narrow strip located on the erosive surface (Fig. 2 ).Figure 2. Candidiasis. Subjective sensations in the form of itching, of course, aggravate the course of dermatosis, since in order to stop these sensations, patients resort to more frequent hygiene procedures, the use of alcohol solutions, which give only a short-term effect. Cream therapy triderm yeast intertrigo, especially with the involvement of large folds in the process, allows to achieve clinical recovery in the initial stage of the disease, and with a significant prevalence and prescription of the process, reduce the treatment time, reduce negative subjective feelings.

Selective damage to the inguinal folds is characteristic of true (inguinal) epidermophytosis. This disease, belonging to the group of dermatophytosis, is characterized by initial clinical manifestations in the form of a hyperemic edematous spot in the depth of the inguinal fold or on the lateral surface of the thigh, closer to the fold. The process can begin as one-sided, further taking on a symmetrical character and a tendency to spread to adjacent areas of the skin in the vicinity of the inguinal folds. Peripheral growth at first bright, then acquiring a stagnant edematous spot, is subsequently accompanied by peeling in its central part, with edema, hyperemia and microvesiculation in the peripheral zone – in the growth zone. This gives the hearth a scalloped, often garland-like appearance. Severe itching often transforms into a burning sensation, soreness, especially when rubbed with clothes or washed with soap. It is these pain sensations in the acute stage of the disease that reduce the ability to use traditional external fungicides, which cause additional discomfort. Use of an easily absorbed cream or ointment triderm , which have a delicate texture, the combined action of the anti-inflammatory fungicidal and antimicrobial components allow within 2 days to reduce the inflammatory reaction, get rid of discomfort and provide an opportunity to use irritating concentrated fungicidal agents or combine the further use of ointment triderm with systemic antimycotic drugs up to complete cure.

Similar to inguinal epidermophytosis, mycosis of smooth skin caused by fungus 9 has a picture0029 Tr. rubrum (Fig. 3). Figure 3. Mycosis of smooth skin caused by Tr. rubrum. Erythematosquamous foci predominate with small nodular, rarely vesicular rash along the periphery of the foci. Usually, the growth of the focus with rubromycosis goes from the lower leg to the thigh and only then to the inguinal folds, i.e. in the direction opposite to that of inguinal epidermophytosis.

The stability and capriciousness of the course of the disease in rubromycosis necessitates persistent treatment with local and systemic antimycotic agents, however, in case of an exudative form or in case of complications with eczematization, it is possible to use a cream triderm , which will reduce the risk of transformation of the process into microbial (mycotic eczema).

Streptococcal intertrigo is a relatively rare type of acute streptoderma that affects large folds. It occurs mainly in children, less often in adults, the favorite area is behind the ears, folds of the lateral surface of the neck in newborns. Perhaps the accession of streptococcal impetigo to itchy dermatoses (scabies). The defeat of large folds by streptococcal infection in adults develops against the background of somatic burden – in violation of carbohydrate metabolism, a decrease in the function of the immune system. The conflicts arising from streptococcal intertrigo of large folds, quickly opening as a result of friction, form erosive foci of polycyclic outlines. A significant amount of serous exudate is separated from the surface of erosions, additionally macerating the erosive surface and the skin around the focus. Wet-drying dressings with disinfectant solutions can be successfully replaced with cream triderm with a further transition to ointments with antibiotics and sulfonamides.

Psoriasis of large folds has its own clinical features. This type of psoriasis vulgaris or exudative psoriasis often occurs in patients with obesity, diabetes mellitus, and thyroid pathology. In the folds, bright red plaques with a shiny, as if varnished surface, clearly demarcated from healthy skin, often appear symmetrically; in the depth of the fold along the line of skin tension, painful deep cracks often appear, indicating infiltration in the lesion. As a rule, there is no peeling of the skin in the area of ​​the rash, since the scales are easily torn off due to exudative changes and friction of the contacting surfaces (Fig. 4). Figure 4. Psoriasis. This clinical picture is very similar to yeast, streptococcal diaper rash. To suppress the exudative inflammatory reaction in the first 7-10 days, it is advisable to apply a cream on the lesions, and then an ointment elokom , then switching to absorbable ointments.

Treatment of bullous dermatoses is largely determined by the combination of general therapy, including primarily glucocorticoid hormones, with topical therapy. Since the introduction into practice of dermatologists of TGCS, the treatment of patients with true pemphigus (Fig. 5), Figure 5. True pemphigus (vulgar). bullous pemphigoid (Fig. 6), Figure 6. Bullous pemphigoid. Dermatitis herpetiformis Duhring (Fig. 7) Figure 7. Dermatitis herpetiformis Duhring. became more effective, facilitating the work of the doctor and the patient’s condition. The main feature of this group of dermatoses is the appearance of blisters, and then long-term non-healing erosions. In large folds, epithelialization is especially slow, despite massive steroid hormone therapy. With all varieties of true pemphigus, bullous pemphigoid, benign familial pemphigus Gougereau-Hailey-Hailey (Fig. 8) Figure 8. Gougerot-Hailey-Hailey disease. the selection of external medicines presents significant difficulties [7].

Currently, cream and ointment triderm or elocom can be used as initial, and in some cases basic external therapy. So, for a long time, it is possible to quite successfully maintain a stable remission in patients with benign familial pemphigus Gougereau-Hailey-Hailey, recommending them to take restorative agents in combination with the external use of cream triderm .

Thus, the introduction of various dosage forms into the practice of dermatologists triderma and elocoma with unique properties of GCS molecules and a balanced composition of active substances made it possible to determine the choice of external agents for the treatment of DCS in favor of these drugs. Their pharmacological properties and therapeutic profile allow the practitioner to make an informed choice in solving the problem of “efficacy or safety?”, which always arises when it is necessary to prescribe TGCS therapy, including in children.

Types of fungal infections, treatment of fungal infections

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The term fungal infections in dermatology is understood as an acute or chronic disease caused by fungal flora, which can be both pathogenic for humans and conditionally pathogenic, that is, causing a pathological process under certain circumstances of reducing the resistance of the human body.

The world of mushrooms is extremely wide and diverse. About 400 species of fungi are known that can cause disease in humans, affecting both the skin and mucous membranes, and internal organs, causing severe damage to the health of a human carrier of the infection.

In recent years, due to the mass, uncontrolled use of antibacterial agents, immunosuppressants by the population, the growth of diseases associated with impaired immunity and various endocrinopathies, fungal infections have become very widespread.

Classification of fungal infections

There is a classification of fungal infections by N.D. Sheklakova:

• Keratomycosis (versus versicolor, piedra, etc.)
• Dermatophytosis (epidermophytosis, trichophytosis, microsporia, rubromycosis, etc.)
• Candidiasis (superficial candidiasis of the skin and mucous membranes, visceral candidiasis)
• Deep mycoses (sporotrichosis, chromomycosis)
• Pseudomycosis (erythrasma, actinomycosis).

However, in many countries of the world, the classification of fungal diseases according to the localization of the pathological process is accepted:

• Tinea pedis – athlete’s foot.
• Tinea corporis – mycosis of the smooth skin of the body.
• Tinea cruris – inguinal mycosis.
• Tinea capitis – mycosis of the scalp.
• Tinea unguim – onychomycosis.
• Tinea manum – mycosis of the hands.
• Tinea barbae – mycosis of the face.

The source of infection in a fungal infection can be a sick person or animal, as well as everyday items contaminated with fungi, agricultural products. Often, with a fungal infection, a person himself acts as a direct carrier and host of the infection that occurred as a result of a general decrease in immunity and developed from opportunistic flora, which is present on the skin normally and does not cause a disease under the condition of healthy immunity. Thus, the presence of a fungal infection on the skin may be evidence of a general health disorder in the patient. Fungal diseases often accompany a disease such as diabetes mellitus.

Skin lesions in a fungal infection can be both localized and widespread, the severity of subjective symptoms can range from the complete absence of any subjective symptoms to severe itching and soreness of the lesions, disrupting the patient’s habitual lifestyle, leading to a decrease in the quality of human life.

For laboratory diagnosis of fungal infections, microscopic and cultural methods are used, in addition, PCR diagnostics are used.

The largest share in the daily practice of a dermatovenereologist was received by various candidiasis, damage to the skin and nail plates by yeast fungi of the genus Candida. With this fungal infection, large folds on the human body and small ones on the hands and feet can be affected, the lesion can be widespread, often a manifestation of candidiasis of the anogenital zone. Often with candidiasis, the nail plates suffer, onychomycosis develops. The second most frequent seekers of medical help are epidermophytosis with lesions of large skin folds, and the third – rubrophytosis with a primary lesion of the skin of the feet. Quite often, fungal infections are still found in the human population, accompanied by hair damage: trichophytosis and microsporia.

The presence of a long-term fungal infection in humans is the basis for a comprehensive examination of the patient, aimed at studying the cause of a decrease in skin immunity. Timely therapy with antifungal drugs should be carried out taking into account the identified comorbidities that led to the development of a fungal infection in a patient.

URO-PRO: treatment of fungal infections

Long-term successful experience in managing patients with various fungal infections by dermatologists at the Uro-Pro clinic, individual selection of drug therapy and development of measures to localize the infection, active participation in solving treatment problems with mutual cooperation between the doctor and the patient, is a guarantee of a complete recovery of the patient, with reducing the risk of re-infection with a fungal infection. When selecting drug treatment, we proceed primarily from the concept of the expediency of prescribing, taking into account the possible risk associated with the use of various chemotherapeutic drugs. All medicines used by us in the treatment of fungal infections are certified and have passed strict clinical control.