Risk Factors, Causes, Symptoms, and Treatment

Intertrigo is a fancy name for a rash that shows up between the folds of skin. It is a very common skin rash that can crop up throughout life.

The most common areas affected include larger skin-fold areas such as:

Symptoms of Intertrigo

What does intertrigo look like? It may cause:

• Red or reddish-brown rash
• Raw, itchy, or oozing skin
• Foul odor
• Cracked or crusty skin

Intertrigo may appear in any skin folds that rub together and trap moisture. In infants, intertrigo often shows up as diaper rash.

Intertrigo can occur:

• Between toes and fingers
• In armpits
• In the inner thighs
• In the groin and at the scrotum
• On the underside of your breasts or belly
• In the crease of your neck
• Between the buttocks

If you have any symptoms of intertrigo, be sure to see your doctor. Your doctor can check for the presence of infection as well.

Causes of Intertrigo

Intertrigo is an inflammatory skin condition that can be caused and worsened by many factors. These include:

• Moisture
• Heat
• Lack of air circulation
• Friction between skin folds

Sweat, urine, and feces can contribute to the skin problem.

Intertrigo is often accompanied by an infection caused by:

• Yeast
• Other types of fungus
• Bacteria

You are more likely to get these infections in skin folds because these are areas that are warm and tend to stay moist. This creates a welcome environment for the growth of germs.

Risk Factors for Intertrigo

You are more likely to develop intertrigo if you:

• Are obese
• Have diabetes
• Have a splint, brace, or artificial limb
• Are exposed to high heat and humidity

Other possible risk factors include:

Infants — with their chubbiness, shorter necks, and flexed posture — are also at greater risk for intertrigo.

Certain skin diseases such as psoriasis may also prompt the development of intertrigo. So it’s a good idea to have a dermatologist check it out.

Prevention and Treatment of Intertrigo

If you or your child has intertrigo, your doctor may suggest simply keeping the affected area dry and exposed to the air. You may control oozing with moist compresses of an astringent called Burow’s solution. Then air-dry with a hair dryer set on “cool.”

A barrier cream may be recommended to help protect skin from irritants.

To treat intertrigo, your doctor may recommend short-term use of a topical steroid to reduce inflammation in the area. If the area is also infected, your doctor may prescribe an antifungal or antibiotic cream or ointment. Sometimes you need an oral medication.

Some simple steps may help lower your risk in the future, such as:

• Shower and dry off thoroughly each day. Keep your skin as dry and cool as you can.
• Avoid wearing tight shoes or clothing.
• Wear a bra with good support.
• If the areas between the toes are affected, consider wearing open-toed shoes.
• For infants with diaper rash, change diapers more frequently.
• If you are overweight, do what you can to lose weight.

How to Prevent and Treat Intertrigo

Wounds in skin folds can be a challenge to prevent and, once present, involve ongoing surveillance and care.

Donald Wollheim, MD, FAPWCA, WCC, DWC, a board-certified surgeon of the American Board of Surgery, shared his insight on best practices for preventing and treating wounds in skin folds if they develop.

What Causes Wounds in Skin Folds?

Skin fold rashes and wounds, also known as intertrigo and intertriginous dermatitis, are generally due to the presence of three factors, said Wollheim:

1. Friction between two layers of skin (skin against skin)
2. Moisture (a buildup between these same two layers of skin)
3. Lack of air flow (to evaporate the moisture)

Wollheim said when one flap of skin lays on top of another, the friction, moisture and lack of aeration causes a rash to develop between the layers of skin.

Next, the outer layer of the epidermis, called the stratum corneum, becomes inflamed because of the moisture.

Common Places Where Intertrigo Occurs

There are some common areas on the body where intertrigo can develop, Wollheim said. They include:

• Axilla: The skin of the adducted arm lies against the skin of the axilla.
• Inframammary: Underneath the breasts, when the skin of the breast lies on top of the skin of the upper abdomen and thoracic wall.
• Abdominal pannis: When the skin of the abdomen flops down on the groin and suprapubic region.
• Perineal: When the two buttocks are lying against each other or when the inferior buttocks lie against the skin of the posterior thigh.
• Genital: Between the perineum and the scrotum or between the labia.
• Interdigital: Between fingers and toes.
• Creases in the neck: Occurs when the neck is thick.
• Prosthetic limb wearers: The area where the stump of the limb rests in the socket of the prosthesis.

What Do Skin Fold Wounds Look Like?

Wollheim said intertrigo appears in a linear manner along the crease where the flaps meet, and looks like a half moon — with nearly an identical mirror image on each flap of the involved skin folds.

Wounds in skin folds (intertrigo) are partial thickness, meaning they involve the top two layers of skin — the epidermis and dermis. And, if a simple case, will typically appear mildly erythematous, Wollheim said.

Patient Symptoms with Intertrigo

According to Wollheim, patients with intrerigo often have some of the following symptoms:

• Burning
• Itching
• Oozing
• Maceration
• Odor
• Pain
• Satellite lesions (if a fungal infection is present)
• Red streaking leading away from the wound (if a bacterial infection is present and indicates the development of lymphangitis)

If a bacterial infection develops, it’s usually a gram-positive organism and more commonly staphylococcus or streptococcus, he said.

“When this occurs, we can also see systemic changes, in addition to lymphangitis (symptoms), such as fever, chills, nausea and vomiting,” Wollheim said.

Risk Factors for Developing Intertrigo

Wollheim said several factors can place patients at risk for developing intertrigo, such as having a history of:

• Obesity (BMI > 30)
• Diabetes
• Wearing a splint, brace or having an artificial limb or limbs
• Immune system suppression
• Living in a warm, humid climate
• Dependency on others (the very young and the elderly) to change diapers (babies/toddlers) and adult briefs (elderly)

Strategies for Preventing Wounds in Skin Folds

To prevent wounds in skin folds from occurring, Wollheim suggests the following strategies:

1. Change diapers and adult briefs frequently (as soon as wet/soiled).
2. Undergarments should be loose (not tight).
3. Use antiperspirants in the axilla.
4. Look for body soaps with a pH of 7.0 (don’t use alkaline soaps with higher pH).
5. Wash and apply topicals with a light touch (avoid vigorous rubbing of skin).
6. Consider using a hand-held hair dryer on the “cool” setting to use in vulnerable areas, such as the abdominal pannis.
7. Take a “brief” holiday — take breaks from wearing diapers (kids) and briefs (adults) whenever possible to allow for aeration. Use bed pads during these times.
8. Work to maintain blood glucose levels within normal range for patients with diabetes. Bacteria and fungi use blood glucose as an energy source.

Once intertrigo develops, Wollheim said it is important to identify the cause to correct the problem.

“If the cause is too much friction, you want to reduce the friction,” he said. “If the root cause is too much moisture, work to reduce the moisture in the affected area.”

Recommended products for intertrigo treatment

Some examples of treatment products Wollheim suggests, depending on the patient and his or her medical history, include:

• Zinc oxide, which also is an antimicrobial and can provide a good barrier.
• A polyester-based, moisture-wicking antimicrobial fabric placed between skin folds (an example is InterDry)
• Antimicrobial Kerlix dressings (AMD Kerlix), which should be changed frequently.
• Aluminum acetate solution to calm the skin and reduce redness and swelling.
• Low-dose steroids to control itching.

If a secondary bacterial infection develops, such as a cellulitis or lymphangitis, Wollheim said it is essential to recognize, diagnose and treat it as soon as possible.

Learn more in our course on Skin and Wound Management today.

Carole Jakucs, MSN, RN, PHN, CDCES

Carole Jakucs, MSN, RN, PHN, CDCES, is a freelance writer and diabetes educator. Her background in nursing includes tenures in healthcare management and as a care provider. She has worked in med/surg/telemetry, a pediatric emergency department and college health.

Treating a Rash in Skin Folds

cybergrannie
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May 27, 20200 found this helpful

Best Answer

First and foremost – I do not believe anyone on this site is qualified to offer/suggest any type of medical treatment.

Since intertrigo is primarily a skin disorder you may find some helpful information online that will help you decide if or when your condition is serious enough to warrant seeing a doctor.

Since this problem can occur in several different areas of the body you will have to adjust to the best method for your personal problem.

I work with a volunteer group that visits ‘shut ins’ and I see this condition quite often. I have seen different methods work but if you find one is working then try to stick with that method.
You can try to keep the area dry as much as possible and some people fold thin white pieces of cloth in the folds to help keep the area dry. Changing them often.
If you live alone you can try methods that you may not wish to use if other people are around.

As to heat lamps – I have never heard or read of anyone doing this and it may be more heat than you need.
If you’re looking to dry the area perhaps a fan or more controllable hair dryer would be preferred.

I can relate some of the measures suggested for this skin rash but please understand that any suggestion is a temporary thing and a rash should be watched carefully to make sure it is healing properly and if not then make a doctor’s appointment – you can see a regular GP or a dermatologist.

“Use a fan or blow dryer on the cool setting to air out the skin fold.
Use a soft towel to gently dry the area several times a day.
Wear clothing made of moisture-wicking fabric (cotton).
Wear loose clothing to avoid trapping moisture against the skin.”

” mild topical steroid like 1% hydrocortisone cream, which is available without a prescription (over the counter, or OTC), and then covered with zinc oxide paste (Desitin). “
You can read some online medical information pertaining to this problem:

www.livestrong.com/…/

www.healthgrades.com/…/what-to-do-for-intertrigo

www.webmd.com/…/intertrigo-symptoms-causes-treatment…

Obesity: Skin issues and skinfold management

Nurses can help reduce injury through proactive assessment and early intervention.

Takeaways:

• A common misconception is that adults who are obese can’t experience malnourishment because their weight suggests excess caloric intake.
• All clinicians should receive education that addresses unconscious bias that may affect their communication and care. Sensitivity training can help increase awareness and compassion.
• Caring for patients who are obese requires an interdisciplinary approach.

According to the Centers for Disease Control and Prevention (CDC), 39.8% of adults in the United States are obese. (See Obesity and BMI.) Obesity and obesity-related conditions—including diabetes, heart disease, hypertension, stroke, elevated cholesterol, sleep apnea, musculoskeletal issues, and poor quality of life—are estimated to cost the country $147 billion to $210 billion per year. Adults who are obese also experience skin issues such as candidiasis, dermatitis, and pressure injuries. In addition, they frequently have multiple skinfolds, some located in atypical locations that pose additional challenges when providing nursing care.

Obesity and BMI

Obesity is categorized by body mass index (BMI), which is calculated by dividing a person’s weight (in kilograms) by height (in meters squared).

Category	BMI
Underweight	< 18.5
Normal weight	18.5 – 249
Overweight	25 – 29.9
Class I obesity	30 – 34.9
Class II obesity	35 – 39. 9
Class III obesity	≥ 40

Skin issues: Contributing factors

Excessive adipose tissue, impaired mobility, malnourishment, and skinfolds all contribute to skin issues in adults who are obese. Excessive adipose tissue has a poor blood supply, leading to inadequate oxygenation, which can impair wound healing. Adipose tissue also insulates the body, trapping heat, increasing patients’ core temperatures, and causing excessive sweating. The result is increased moisture, especially in skinfolds, that leads to fungal or bacterial growth.

Impaired mobility among adults who are obese can contribute to pressure injuries. Sources of pressure include the surface the patient is sitting or lying on, such as beds and wheelchairs, as well as medical equipment and devices such as catheter tubing. In addition, some patients may be unable to reach parts of their bodies, leading to poor hygiene.

A common misconception is that adults who are obese can’t experience malnourishment because their weight suggests excess caloric intake. However, their diets may be deficient in proteins and other nutrients essential to healing. Nutrient and vitamin deficiencies impact skin health and hinder healing when skin injuries occur.

Unusually deep skinfolds are unique to adults who are obese. In addition to skinfolds in expected areas of the body, they also may occur in atypical areas such as the neck, arms, breasts, abdomen, legs, and ankles. These folds are at risk for shearing and friction, which can contribute to more skin problems.

Common skinfold issues and skinfold care

Skinfold issues in adults who are obese require care and monitoring. Nurses should understand assessment and treatment for each of these.

Moisture control

The warm, moist, and dark skinfold environment is ideal for microorganism growth. A common culprit is Candida albicans, which can result in candidiasis. This condition presents as bright red, eroded skin that may include papules, plaques, pustules, and classic satellite lesions. Odor frequently is noted with candidiasis, which many patients find distressing.

To control moisture, advise patients to avoid tight clothing; use pH-balanced liquid soap, cleansers, or disposable wipes; and pat skinfolds dry, rather than aggressively rubbing. Hair dryers set on cold also can be used to dry skinfolds. Daily inspection of the skin, routine cleansing, and moisturizing as needed by patients and caregivers is beneficial.

Topical antifungals, such as nystatin powder, frequently are used to treat candidiasis. If topical therapy fails, a short-term oral antifungal may be necessary. However, antifungals address only the microorganism; moisture management is required to resolve the infection.

Other products are available for patients who have refractory skin issues despite good standard care. For example, a polyester knit textile product impregnated with silver can help absorb and wick away moisture and control odor. This product also provides antimicrobial action for up to 5 days. It’s placed at the base of the skinfold, extending about 2 inches beyond the fold. This product can be expensive and may not be necessary for everyone; reserve its use for special cases, including patients with antifungal allergies.

Intertriginous dermatitis

Intertriginous dermatitis (intertrigo) is an inflammatory condition in skinfolds. It may present as mild to moderate redness with skin erosion, drainage, maceration, and crusting. It usually is partial thickness and mirrors the pattern of skin breakdown on the opposite or “kissing” side of the skinfold. The condition, which can be painful, may develop as a secondary infectious process caused by C. albicans or bacteria. Caring for intertrigo includes moisture control, which can involve zinc oxide–based barrier creams or absorbent dressings depending on the condition’s severity.

Pannus care

The abdominal pannus (fold of excess abdominal fat and skin) is a common problem area for adults who are obese. (See Abdominal pannus grading.) A large pannus can significantly limit mobility, causing gait alterations and pain with ambulation. In addition, the pannus may lead to pressure injury formation, friction and shearing, moisture trapping, hygiene difficulty, and lymphatic changes that contribute to skin breakdown and infection (panniculitis).

Abdominal pannus grading

An abdominal pannus can be described using a grading scale from 1 to 5, where 5 is the most severe.

Grade     Description

1          Covers the pubic hairline but not the entire mons pubis

2          Extends to cover the entire mons pubis

3          Extends to cover the upper thigh

4          Extends to midthigh

5          Extends to the knee and beyond

Source: Blackett et al.

Pannus assessment requires lifting it to visualize the base of the skinfold. In some cases, multiple staff and lifting devices or slings may be needed. Watch for pannus skin irritation and skin breakdown, including intertrigo, candidiasis, and painful skin erosions. Panniculitis can be difficult to prevent and treat, and it may recur. Treatment for panniculitis typically involves systemic antibiotics and skinfold care. In extreme cases, surgical debridement or removal of the pannus (panniculectomy) may be considered. Keeping the pannus clean and dry is the best way to prevent infection and other issues.

Perineal care

Genital and perineal skin can be especially challenging to care for in patients who are obese. They may have deep skinfolds in the groin and buttocks with high friction and increased moisture from perspiration, which may be compounded by incontinence. Perineal care requires carefully assessing these areas while respecting a patient’s modesty and comfort. Cleaning and drying the skin gently but thoroughly and applying barrier products (films or creams) after any incontinent episodes are recommended.

Barrier products can protect skin from repeated exposure to bodily fluids, especially urine and feces, that can irritate the skin; wicking fabrics are impractical because of toileting or incontinence. Note that ingredients in some barrier products can impair the absorbency of incontinence products. Using too much product can cause skin cracking and discomfort, and some products can obscure skin assessment. Also consider patient allergies when choosing a barrier product.

Hygiene after toileting can be challenging for patients who are obese, increasing the risk of skin breakdown or infection in the genital and perineal area. Washcloths or premoistened wipes may be preferable to toilet paper, and using a handheld showerhead when bathing may aid hygiene.

Pressure injuries

Foreign objects, such as catheter tubing or a cell phone, can get trapped between skinfolds and lead to device-related pressure injuries. In addition, atypical pressure injuries may occur because of pressure from bed rails, chair arms, or wheelchair foot and calf rests. Immobile patients may develop pressure injuries on their heels and sacrum. Provide floating heels as indicated and help patients turn and reposition.

Acanthosis nigricans

Acanthosis nigricans is characterized by areas of dark, velvety discoloration in skinfolds and creases; it’s sometimes mistakenly associated with poor hygiene because of the dark color and skin thickening. The condition, which may be seen in the neck, axilla, and inguinal folds, is common among people with darker skin pigmentation. No cure exists for this condition, but glucose control and weight loss may help. A dermatologist may be able to provide cosmetic treatments to improve skin appearance.

Other considerations

Caring for patients who are obese requires an interdisciplinary approach that includes physical therapists (for mobility issues), occupational therapists (for help with devising or recommending effective tools patients can use to clean themselves after toileting), physicians (for medical needs), dietitians (for nutritional intervention), speech therapists (for difficulty swallowing because of anatomic shifting caused by weight gain), mental health professionals (for anxiety and depression), chaplaincy (for spiritual needs), and wound, ostomy, and continence nurses (for skin and wound care management). Proper care also requires clinician education and attention to patient, personal caregiver, and clinician safety.

Clinician education

All clinicians should receive education that addresses unconscious bias that may affect their communication and care. Sensitivity training can help increase awareness and compassion. Listen to patients, make eye contact with them, and involve them in care plans. Find opportunities to ensure patient dignity. For example, encourage toileting or scheduled toileting rather than adult diapers.

Safety

When assessing and cleaning skinfolds, take steps to ensure patient, caregiver, and clinician safety. For very heavy skinfolds, mobilization devices such as pannus lifts may be necessary. Enlist a sufficient number of trained staff to slowly and carefully move the patient and skin. If the patient is at home, train dependable family members and responsible caregivers to properly use any special equipment.

Appropriate-size lift equipment may be necessary to turn and mobilize patients out of bed. Bariatric chairs and beds are recommended, as are toilet risers with handrails or bariatric commodes or toilets that can accommodate the patient’s size and weight. Inappropriate-size equipment may increase pressure injury risk or other harm (for example, falling out of an inappropriate-size chair).

Care with confidence

Skinfold management (assessment, hygiene, and safe handling) is vital to caring for patients who are obese. Advocate for adequate staffing, safe handling techniques, and appropriate equipment and supplies, as well as patient, personal caregiver, and clinician education. Each patient has different needs. You can address them with confidence when you have the tools and knowledge to provide evidence-based care.

Armi S. Earlam and Lisa Woods are wound, ostomy, and continence nurses at Lutheran Medical Center in Wheat Ridge, Colorado.

References

Beitz JM. Providing quality skin and wound care for the bariatric patient: An overview of clinical challenges. Ostomy Wound Manage. 2014;60(1):12-21.

Black J, Hotaling T. Ten top tips: Bariatric skin care. Wound Inter. 2015;6(3):17-21.

Blackett A, Gallagher S, Dugan S, et al. Caring for persons with bariatric health care issues: A primer for WOC nurses. J Wound Ostomy Continence Nurs. 2011;38(2):133-8.

Centers for Disease Control and Prevention. Overweight and obesity: Adult obesity facts. February 27, 2020. cdc.gov/obesity/data/adult.html

Fencl JL, Walsh A, Vocke D. The bariatric patient: An overview of perioperative care. AORN J. 2015;102(2):116-31.

Fletcher J. Appropriate selection and use of barrier creams and films. Wound Essentials. 2016;10(2):64-8.

Hebert GR. Providing skin care for bariatric patients. Wound Care Advisor. 2015;4(6). woundcareadvisor.com/providing-skin-care-for-bariatric-patients-vol4-no6

Holsworth C, Gallagher S. Managing care of critically ill bariatric patients. AACN Adv Crit Care. 2017;28(3):275-83.

McGinley LD, Bunke J. Best practices for safe handling of the morbidly obese patient. Bariatric Nurs Surg Pt Care. 2008;3(4):255-60.

Morello SS. Skin and wound care for the bariatric population. In: Doughty DB, McNichol LL, eds. Wound, Ostomy and Continence Nurses Society® Core Curriculum: Wound Management. Philadelphia, PA: Wolters Kluwer; 2016; 242-252.

Rush A, Muir M. Maintaining skin integrity bariatric patients. Br J Community Nurs. 2012;17(4):154, 156-9.

Shipman AR, Millington GW. Obesity and the skin. Br J Dermatol. 2011;165(4):743-50.

VHA Center for Engineering & Occupational Safety and Health. Bariatric Safe Patient Handling and Mobility Guidebook: A Resource Guide for Care of Persons of Size. July 2015. asphp.org/wp-content/uploads/2011/05/Baraiatrice-SPHM-guidebook-care-of-Person-of-Size.pdf

Diaper Rash | Andover Pediatrics

Diaper rash can be any rash that develops inside the diaper area. In mild cases, the skin might be red. In more severe cases, there may be painful open sores. You will usually see a rash around the abdomen, genitalia, and inside the skin folds of the thighs and buttocks. Mild cases clear up within 3 to 4 days without any treatment. If the rash persists or develops again after treatment, consult your child’s pediatrician.

What causes a diaper rash?

Over the years diaper rash has been blamed on various causes, such as teething, diet, and ammonia in the urine. However, medical experts now believe it is caused by any of the following:

• Too much moisture
• Chafing or rubbing
• Prolonged contact of the skin with urine, feces, or both
• Yeast infection
• Bacterial infection
• Allergic reaction to diaper material

When the skin stays wet for too long, the layers that protect it start to break down. When wet skin is rubbed, it also damages more easily. Moisture from a soiled diaper can harm your baby’s skin and make it more prone to chafing. When this happened, a diaper rash may develop.

Further rubbing between the moist folds of the skin only make the rash worse. This is why diaper rash often forms in the skin folds of the groin and upper thighs.

More than half of babies between 4 months and 15 months of age develop diaper rash at least once in a 2-month period. Diaper rash occurs more often in the following instances:

• As infants get older-mostly between 8 to 10 months of age
• If babies are not kept clean and dry
• In babies who have frequent stools, especially when the stools stay in their diapers for long periods of time/overnight.
• When babies begin to eat solid foods
• When babies are taking antibiotics, or in nursing babies who mothers are taking antibiotics

Infants taking antibiotics are more likely to get diaper rashes caused by yeast infections. Yeast infects the weakened skin and causes a bright red rash with red spots at its edges. You can treat this with over-the-counter antifungal medications. If you see these symptoms, you may wish to consult with your pediatrician.

What can I do to prevent diaper rash?

To help prevent diaper rash from developing, you should:

• Change the diaper promptly after your child wets or has a bowel movement. This limits moisture on the skin.
• Do not put the diaper on airtight, especially overnight. Keep the diaper loose so that the wet and soiled parts do not rub against the skin as much.
• Gently clean the diaper area with water. You do not need to use soap with every diaper change or after every bowel movement. (Breastfed infants may stool as many as 8 times a day).
• Do not use talcum or baby powder because they could cause breathing problems in your infants.
• Avoid over-cleansing with wipes that can dry out the skin. The alcohol or perfume in these products may irritate some babies’ skin.

What can I do if my baby gets diaper rash?

If diaper rash develops despite your best efforts to prevent it, try the following:

• Change wet or soiled diapers often.
• Use clear water to cleanse the diaper area with each diaper change.
• Using water in a squirt bottle lets you clean and rinse without rubbing.
• Pat dry; do not rub. Allow the area to air dry fully.
• Apple a thick layer of protective ointment or cream (such as one that contains zinc oxide or petrolatum) to form a protective coating on the skin. These ointments are usually think and pasty and do not have to be completely removed at the next diaper change. Remember, heavy scrubbing or rubbing will only damage the skin more.
• Check with your pediatrician if the rash:
  • Has blisters or pus-filled sores
  • Does not go away within 48-72 hours
  • Gets worse

Diaper rash is usually not serious, but it can cause your child discomfort. Follow the steps listed above to help prevent and treat diaper rash. Discuss any questions you have about these steps with your child’s pediatrician.

Granuloma annulare – NHS

Granuloma annulare is a rash that often looks like a ring of small pink, purple or skin-coloured bumps.

It usually appears on the back of the hands, feet, elbows or ankles. The rash is not usually painful, but it can be slightly itchy. It’s not contagious and usually gets better on its own within a few months.

Granuloma annulare is more common in children and young adults, although it can affect people of all ages. It’s about twice as common in women.

Types of granuloma annulare

Here are some of the main types of granuloma annulaire:

Localised granuloma annulare

The most common type, localised granuloma annulare, appears in just 1 or 2 areas, tends to affect children and young adults, and usually gets better on its own after a few months.

Pink, purple or skin-coloured patches typically appear on the fingers, backs of the hands, feet, ankles or elbows. 

They form rings that grow slowly until they’re about 2.5-5cm across. As the rings get bigger, they become flatter and more purple in colour before eventually fading.

Credit:

In localised granuloma annulare, the top of the skin feels smooth and, unlike in other skin conditions, such as pityriasis versicolor, ringworm or eczema, it is not rough, dry or scaly.

The affected skin also feels firm as a result of inflammation in the middle layer of skin (dermis). There’s no change in the outermost layer of skin (epidermis).

Widespread granuloma annulare

More rarely, you can develop a widespread rash, known as generalised or disseminated granuloma annulare. It usually affects adults.

Large pink, purple or skin-coloured patches appear on a larger portion of the body, including the trunk, arms and legs.

Credit:

The rash is sometimes made up of small raised spots that form symmetrical rings 10cm or more across. They’re often found in skin folds in the armpits and groin.

Under the skin

Granuloma annulare under the skin usually affects children. One or more firm, rubbery lumps develop under the skin.

They can range from 5mm-4cm in size.

They can appear on the shins, ankles, feet, buttocks, hands, scalp and eyelids.

Treating granuloma annulare

Unfortunately, there’s no really effective treatment for granuloma annulare. But in most cases, treatment is not necessary because the rash will disappear on its own within a few months to 2 years.

For more severe cases, you could ask a doctor about the following treatments:

• steroid creams or ointments may help, but they must be used carefully because long-term use can thin the skin
• cryotherapy (freezing the bumps) may be an option for treating very small patches, but it can be painful and cause permanent scarring
• ultraviolet light treatment and powerful medicines (such as steroid tablets, antibiotics, antimalarial medicines, isotretinoin, ciclosporin and dapsone) have been reported to help in individual cases of widespread granuloma annulare, but for most people the symptoms of granuloma annulare do not justify using these treatments as they all have significant side effects

If you find the appearance of the rash upsetting, you could try using skin camouflage products.

Read more about skin camouflage products and Maria’s experience of using them.

Intertrigo – an overview | ScienceDirect Topics

Environmental skin disease

Intertrigo

Intertrigo occurs in areas of skin-to-skin contact; excessive motion results in moist dermatitis and inflammation because of friction. This most commonly occurs in ruminants between the udder and the inner aspect of the thigh. Treatment includes cleansing the region and applying an astringent ointment with the goal of drying the lesion. The disease is self-limiting in most animals, but pain may cause apparent lameness; moreover, the area may have a foul odor and secondary infection may increase the risk of mastitis.

Callus

A callus is formed on areas of the skin that receive chronic mild to moderate abrasion from objects in the environment. The most common location in small ruminants is the dorsal aspect of the carpi and the sternum. Other locations include the cranial aspect of the stifle and the caudal aspect of the elbow. These lesions are normal unless they have associated exudate, swelling, or pain.

Hematoma

Blunt trauma can result in the formation of a hematoma. Hematomas may develop in exposed highly vascular tissues such as the ears or on the main body. Causes of trauma include injury from horned and antlered animals, fighting injury, attack by dogs or other predators, equipment-related injury, and entanglement with fences or other objects. Spontaneous bleeding under the skin is rare but may occur if ingestion of toxins causes coagulopathy. Ultrasonographic findings may suggest hematoma, but a definitive diagnosis requires needle aspiration of blood following aseptic preparation. Unless the hematoma is enlarging, they are best left to resolve with time.

Cutaneous ulceration

Pressure sores (or cutaneous ulcerations) form when bony prominences are in prolonged contact with hard surfaces. They most commonly occur when small ruminants rest in lateral recumbency because of musculoskeletal or neurologic disease. Pressure sores form because of prolonged ischemia and cellular injury (pressure necrosis). They can therefore be prevented or controlled by frequent movement of the animal. Contact with moist surfaces can accelerate this process because hydration of the skin weakens its resistance elasticity.

Foreign bodies

Foreign bodies can become lodged in the skin by injury or surgery. In a study of skin reaction to suture materials in Borno white goats, researchers found that a prolonged inflammatory phase was associated with nylon and silk but not cotton or stainless steel suture material.¹⁴² Stainless steel and nylon sutures produced a moderate amount of granulation tissue reaction, cotton suture produced a marked granulation response, and silk produced the smallest amount of granulation. Wounds sutured with cotton or stainless steel healed faster than those sutured with nylon or silk.

Subcutaneous emphysema

Penetrating wounds or full-thickness lacerations that act as one-way valves can result in subcutaneous emphysema. In these cases, air is allowed to enter but not freely exit from the subcutaneous tissues (bellows effect). Subcutaneous emphysema also occurs in sheep and goats with pneumonia, especially after parturition. The weakened lung parenchyma may rupture into the mediastinum if excessive intrathoracic pressure is applied against a closed glottis (as occurs during parturition). The air dissects along tissue planes and exits through the thoracic inlet to the subcutaneous spaces.

Clinical signs.

Subcutaneous emphysema typically is noted along the neck, dorsal to the shoulder; it may dissect along the back. The condition also may occur with clostridial infections. Often affected animals are found dead and subcutaneous emphysema is discovered during necropsy. However, emphysema may be noted on physical examination early in the infectious process. Clostridial disease should be considered in the differential diagnosis if the animal exhibits severe systemic disease in the presence of subcutaneous emphysema. The condition may also occur as a sequela to a transtracheal wash.

Burns

Skin burns are most commonly found on animals that have been trapped in building fires. Pour-on products containing alcohol are flammable but usually do not ignite the hair coat and do not continue to burn after the fluid volume is consumed. Burns may be classified by severity and extent of the body surface area involved. Sequelae of burn injuries include secondary infection, especially with Pseudomonas, and hypoproteinemia from protein exudation from the wounds. Severe or extensive burns are more likely to result in fatal infection or protein losses. Smoke inhalation and thermal damage to the lungs also can cause death. The clinician should perform a thorough evaluation of the thorax after the initial injury and follow up later because the onset of clinical disease may be delayed. Burns in neonates are likely to occur as a result of inappropriate heat lamp placement in maternity pens. Lambs, kids, and fawns stand under the lamps for warmth and may burn the dorsum as a result. Pour-on products or irritants such as creosote and strong iodine can cause chemical burns on areas of skin contact.

Clinical signs.

Depending on its severity, a burn may produce only superficial scabbing or it may result in serum exudation and suppuration with deeper skin layer involvement. Because wool is fire-retardant, the most severe burns on sheep exposed to barn or grass fires are likely to be found around the head and limbs, whereas goats are likely to have severe burns over their entire bodies.

Treatment.

Evaluation of the patient’s overall condition is essential in a fire because smoke inhalation and thermal damage to the respiratory tract may cause death. Treatment is aimed at preventing or controlling secondary infection. Pain management and administration of plasma (if needed to address hypoproteinemia caused by excessive serum exudation from the wounds) are common therapeutic elements.

Sunburn

Sunburn in animals, as in human beings, is caused by skin damage from ultraviolet light. Sunburn is different from photosensitization.^133,134 It is more commonly seen in white-faced sheep (especially on the face and ears), particularly those that have been recently shorn, leucistic and piebald deer, and light-colored goats (especially on the udders, ears, and nose).¹³³ Fawns that have been bottle raised indoors may suffer severe sunburn, especially on their ears, once they are released outside. Prolonged sun exposure is associated with tumors (e.g., squamous cell carcinoma).

Clinical signs.

Clinical signs of sunburn include erythema, swelling, crusting of skin, head shaking, and pruritus. If the udder is affected, animals will resent milking or being nursed.¹⁴³

Treatment.

Treatment includes the application of pigmented teat dips and the application of sunburn lotion on the udder (for dairy goats), the provision of adequate shelter, and gradual light exposure for light-pigmented animals. In cases of secondary bacterial infection, the use of topical or systemic antimicrobial agents is warranted.^133,134

Frostbite

Prolonged exposure to extremely cold temperatures may result in frostbite. Young stock are most prone to frostbite injury, and the extremities (ears, tail, and feet) are most commonly involved. It is especially a problem in a newborn that is not adequately dried off in cold weather.¹⁴⁴ Death from low body core temperature ensues if treatment is not initiated before vital organs are compromised. Frostbite may occur at a variety of temperatures depending on environmental conditions (sunlight, moisture, wind).⁷⁷ Injury is caused by vasoconstriction, subsequent arterial thrombosis, and ischemic necrosis. After sloughing, damaged ears tend to be rounded with alopecic tips.¹³³ If the surface of the skin is wet, ice crystals can form, accelerating the process. Frostbite injuries occur in four phases.^145,146 Phase 1 (prefreeze) is characterized by arteriolar constriction, venous dilatation, congestion, and serum transudation. Phase 2 (freeze-thaw) begins with extracellular ice crystal formation. Phase 3 (vascular stasis) is denoted by more severe and persistent venous dilatation and arterial spasm, which causes arteriovenous shunting and tissue hypoxia. Phase 4 (ischemia) is denoted by nervous tissue damage caused by prolonged local hypoxia.

Treatment.

The therapy for frostbite may result in reperfusion injury. Nevertheless, it should be instituted immediately and continued for at least the first few days after injury. Warming in water of 104° to 106° F is recommended, as is the use of antibiotics and antiinflammatory drugs as needed to control tissue damage. Necrotic tissue should be debrided as needed to facilitate healing and limit secondary bacterial infection.

Prevention.

An easily accessible shelter should be provided. For each degree drop in ambient temperature below 0° C, the keeper should offer a 0.5 to 1% increase in feed. Feeding ewes and does in barns keeps them and their lambs, fawns, and kids out of the cold weather and in a warmer condition.

Wool slip and wool break

Goats naturally shed their coats in spring. Sheep, however, continuously grow wool and should not shed it. Shorn sheep being housed for winter can, however, experience complete loss of wool (wool slip).^133,143 The affected skin is smooth and free of ectoparasites and shows no signs of disease. No treatment is required and the wool does grow back.^133,143 Wool slip has been associated in some sheep with copper deficiency (low serum copper and cold stress).¹⁴³ Therefore, possible deficiencies in dietary copper should be investigated. Stressors such as parasitism and systemic disease can cause sheep to undergo a cessation in wool growth and can weaken the fiber (wool break). Wool can be lost within days of a systemic stress (anagen defluxion) or within 2 to 3 months after the stress (telogen defluxion). In both cases, the wool does grow back over time. The practical application of this information is in educating the owners of pet sheep that survive a systemic illness—the clinician should warn the neophyte owner of the potential for fiber loss. Anagen defluxion can also occur in goats under stress or due to the stress of disease.

90,000 Sores, rash on the belly of a dog: causes, diagnosis and treatment

Contents of article

A rash on the body of an animal is a symptom of a disease or disorder, the causes of which can be very different. However, acne, scratching and especially sores with crusts will never go away on their own, but can cause serious complications. Therefore, the dog needs professional treatment, which can only be prescribed by an experienced veterinarian. Contacting a specialist when a disease is detected at an early stage will save the pet from suffering.

Causes of a rash on the abdomen in a dog

Such signs are not always a symptom of a serious illness, but may indicate the presence of disorders in the body.

Most often, rashes and other skin defects appear in the following cases:

1. Allergy. Unfortunately, animals are also susceptible to this “scourge” of the XXI century. Rashes can be provoked by both external factors (aerosols, household chemicals, unsuitable means for washing a dog, etc.), and internal (food, medication, accidentally eaten plant).With an allergic reaction, the dog suffers not only from rashes, but also from severe itching. Often it is the abdomen and groin area that is affected, especially in puppies, because the skin here is the thinnest, most delicate and sensitive.
2. Ectoparasites (fleas, lice, lice, mites and scabies). All these creatures settle on or under the skin, bite an animal or gnaw through painful passages. They provoke severe itching and pain. The dog is actively combing the skin, especially on the belly, where it is very delicate.
3. Diaper rash. As strange as it sounds, some dog breeds suffer from them in the same way as small children. In dogs, this is caused by sweating or ingress of moisture, dirt into extensive skin folds, so the rash is more typical for breeds such as pugs, shar Pei, mastiffs, bulldogs. Pimples can be located in any fold, but they spread especially strongly on the abdomen and in the genital area, anus. The condition intensifies at elevated air temperatures and when the animal is overweight, with insufficient care for it.
4. Skin diseases – dermatitis, eczema and others. They can be caused by external stimuli or internal pathologies, including nervous shocks. Sometimes sensitive dogs react with rashes to changes in diet, moving, participating in exhibitions and even the arrival of a new family member, be it a child, puppy or other pet.
5. Bacterial infections. They are more often secondary, joining the underlying disease. If the dog scratches too vigorously or otherwise injures the skin on the abdomen, infection can lead to suppuration, inflammation, and the formation of painful rough crusts.Increased itching and pain leads to further scratching, which even more actively spreads the infection and aggravates the disease.
6. Fungus. Lichens and other types of fungal infections sometimes affect dogs. Young animals with fragile immunity, as well as old and chronically sick dogs, suffer more often. Fungi are dangerous to humans and spread easily, especially if the animal is actively in contact with fellows or other pets, family members. Lichen can “settle” on any part of the dog’s body, damaging not only the skin, but also causing focal or total baldness.This condition can leave rounded pinkish scaly patches on the body, visible on the belly, where the coat is light, short and sparse in most puppies.

Poor hygiene or, conversely, a manic desire for cleanliness of a pet can lead to a deterioration in the condition of the coat, dry skin, flaking and cracks. If measures are not taken in time, the condition may worsen due to a secondary infection of a bacterial or fungal nature.

Do not wash a dog with preparations intended for humans, let alone use household chemicals, “coarse” alkaline soap.Launching an animal in the hope that it will clean itself is reckless, especially if the dog lives in the yard or in inappropriate conditions. But washing more often than once a month is not beneficial, as it removes the lipid layer, leaving the dog’s skin and coat defenseless against external influences.

Diagnostics

It is impossible to determine the nature of the disease by the appearance of the rash, therefore, in order to receive the correct full-fledged treatment, a diagnosis by a veterinarian is necessary. He will conduct an examination, take samples that will indicate the causative agent of the disease.The prescribed treatment will be specialized and complex, which means it will help you quickly cope with the problem and avoid the development of complications.

Treatment methods

First of all, it is necessary to eliminate the cause of the disease. If it is an allergy, then you need to eliminate the allergen – the wrong food, medicine, chemical, and so on. If there are parasites, you need to remove them, and then treat the rash, otherwise there will be no positive result.

If a dog suffers from dirt or diaper rash, then it must be washed with a special medicated shampoo, and the wounds should be treated with a disinfecting drying agent.With proper care, these symptoms disappear quickly.

It is much more difficult to cope with skin diseases caused by internal problems of the body. Hormonal and endocrine pathologies, improper digestion, and disturbances in the functioning of the nervous system can provoke rashes on the abdomen. Accurate diagnosis and comprehensive treatment will be required, including getting rid of the underlying disease and impact on damaged skin and hair.

In case of a bacterial infection, antibiotic-based ointments are prescribed, in severe conditions – taking medications by mouth.It is forbidden to use “human” medicines for dogs, since it is impossible to accurately calculate the safe dosage for a particular animal. Follow the advice of your veterinarian.

Treatment of a fungal infection consists in the isolation of the animal from other pets and children, the appointment of special antifungal and disinfectants. The dog is prescribed antihistamines to relieve itching, making sure that it does not scratch.

The sooner complex professional treatment is started, the lower the risk of complications and the transition of the disease into a protracted, chronic course, weakening the dog and dangerous to his health.

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90,000 Anal itching – causes of occurrence, for what diseases it occurs, diagnosis and treatment methods

IMPORTANT!

The information in this section cannot be used for self-diagnosis and self-medication.In case of pain or other exacerbation of the disease, diagnostic tests should be prescribed only by the attending physician. For a diagnosis and correct prescription of treatment, you should contact your doctor.

Anal itching: causes of appearance, for what diseases it occurs, diagnosis and methods of treatment.

Definition

Anal itching, or itching of the anogenital, anorectal region, characterized by an intolerable desire to scratch the skin adjacent to the anus (the lumen of the anal canal).On the skin in the anus, areas of irritation, scratching and crusts appear. Most often, itching bothers patients in the late afternoon or at night.

Burning and itching disturb sleep, lead to anxiety, irritability, neurosis.

Types of anal itching

It is customary to distinguish between primary (idiopathic) and secondary anal itching.

Possible acute manifestation of itching and chronic course. Acute itching is characterized by a sudden onset.In the chronic course of the process, itching sometimes weakens or stops, but then resumes with the same intensity.

Possible causes of anal itching

Primary (idiopathic) anal itching can be caused by inadequate hygiene of the perineal area, as a result of which, due to poor cleansing of the anus, traces of fecal matter irritate the skin. The same situation occurs with the failure of the sphincter of the anus, when the liquid part of the intestinal contents leaks during the passage of gases and stretching of the rectum.

Secondary anal itching is one of the symptoms of certain diseases.

Diabetes mellitus . Skin manifestations in the early stages of diabetes mellitus can sometimes serve as signaling markers of the disease. Especially often itchy dermatoses are observed in latent and mild forms of diabetes.

In many patients, itching occurs six months or more before the diagnosis is made.

In this case, the most common localization of itchy areas are the folds of the abdomen, the perineum, and the intergluteal region.

In patients with psoriasis, allergic dermatitis and contact dermatitis , itchy areas may be located in different areas of the body. The appearance of a rash on the skin of the buttocks and perineum is accompanied by severe, often excruciating itching.

In contact dermatitis, anal itching can be caused by allergic components of paper and wet wipes, underwear, or in detergents used for personal hygiene.

The onset of itching at hemorrhoids is caused by the fact that large hemorrhoids prevent the anal sphincter from fully closing, and the liquid part of the stool gets on the skin around the anus, causing it to irritate.Another factor that leads to itching is the constant hydration of the skin due to the use of laxative suppositories. Other symptoms of hemorrhoids include discomfort, pulling pain after a bowel movement, mucus and drops of red blood from the rectum.

Harbingers of hemorrhoids for a long time (from several months to several years) can be unpleasant sensations in the anus and anal itching.

Pinworm worms parasitize mainly in the large intestine, causing enterobiasis .When laying eggs, the females of these parasites crawl out through the rectum into the outer part of the anus, resulting in burning and itching.

Enterobiasis is most often affected by children under the age of 12 years.

In addition to pinworms, anal itching can be caused by tapeworms, roundworms, lamblia, etc.

Microscopic fungi easily multiply on the wet skin of the perineum. Candidiasis , which begins on the lining of the rectum and vulva and vagina in women, spreads further, causing itching, burning and irritation of the skin.The development of candidiasis is facilitated by a decrease in immunity, oncological diseases, an imbalance of microflora due to diseases or taking antibacterial drugs, diseases of the rectum, which are accompanied by cracks, erosion, leakage of liquid intestinal contents.

Chlamydia can affect the mucous membranes of the genitourinary tract, eyes, throat and pelvic organs. With the development of chlamydial infection in the rectum, the clinical picture of the disease is mainly asymptomatic, and clinical manifestations may include itching and burning in the anorectal region and minor yellowish discharge.There may also be painful urge to defecate and mucopurulent discharge mixed with blood. The skin around the anus looks red and swollen.

Crohn’s disease and ulcerative colitis (inflammatory bowel disease) are often accompanied by anal itching. The mucous membranes of not only the small, colon and rectum are affected, but also the oral cavity and anus.

Most patients have anal and perianal lesions (anal fistulas, fissures), which aggravates the manifestations of itching.

Diffuse bowel polyposis syndrome . Polyposes – outgrowths on the mucous membrane of the intestinal wall – are often asymptomatic, but in some cases, patients may have bloody and mucous discharge, abdominal pain, and when polyps are located in the rectum (end part of the intestine) and anus – constipation, diarrhea, anal itching.

Anal itching with proctitis (inflammation of the mucous membrane of the sigmoid or rectum) appears due to the bulging of the mucous membrane of the rectum into the lumen of the anus and the ingress of its discharge (mucus, traces of blood) on the surrounding skin.Proctitis occurs as a result of trauma, constant mechanical and chemical irritation (frequent enemas, massage of the prostate gland, eating spicy food). The disease also develops after radiation therapy for malignant tumors (radiation proctitis) or infections (gonorrheal proctitis). In the chronic course of the process, the patient has a feeling of discomfort, incomplete emptying of the intestines, frequent urge to defecate.

With chronic paraproctitis (inflammation of the tissues surrounding the rectum, in particular, fatty tissue), anal itching is associated with the ingress of pus and mucus on the skin from the fistulous tract, which is located next to the anus.The disease is caused by pathogenic microorganisms that invade the tissues surrounding the rectum, through the anal glands or damaged mucous membrane. Sometimes the formation of several fistulous passages is observed, from which pus and feces are released.

Anal itching can be one of the symptoms oncology of the rectum . For a long time, malignant tumors can disguise themselves as benign formations, manifesting themselves only as discomfort during bowel movements, anal itching, and sometimes a non-healing ulcer.Pain in the anus at the onset of the disease is observed only during bowel movement.

Cryptitis (inflammation of the morgan crypt). Morgan crypts are channels through which the secretion of the anal glands is diverted into the rectum. With inflammation of the crypt, which can be caused by injuries by hard feces, chronic inflammatory processes (for example, anal fissures), constant itching occurs in the anus. The pain has a “scratching” character and increases with bowel movements, an admixture of blood may be present in the feces.The course of cryptitis has an undulating character, often patients consider the period of remission a complete recovery.

If untreated, cryptitis can be complicated by paraproctitis.

Which doctor should i contact if there is anal itching

If anal itching occurs in children, first of all, you should contact
pediatrician. Adult patients need to visit
a therapist for referrals for tests and a proctologist.To exclude diabetes mellitus, the therapist may refer the patient to
endocrinologist. If the allergic nature of anal itching is confirmed, further treatment will be continued by an allergist-immunologist.

Diagnostics and examinations with the appearance of anal itching

To diagnose a disease, the symptom of which is anal itching, an analysis of feces for enterobiasis, clinical blood and urine tests, blood tests for glycated hemoglobin 18, fungal infections, autoimmune antibodies are prescribed.

Clothes head lice: signs, sanitation and prevention measures

Pediculosis is a specific parasitism on a person of lice that feed on his blood.

Head lice, clothes lice and pubic lice can parasitize humans . It is possible to be affected by mixed head lice (for example, the simultaneous presence of head and body lice).

Light gray body lice with a body length of up to 5 mm. They live for about 2 months and multiply rapidly, postponing up to 300 nits in a lifetime (6-14 daily).In periodically removed and put on clothes, the development of lice can take up to 6 weeks, while in non-removable underwear – 7-10 days.

The clothes louse prefers warmer places, does not like light, and therefore hides in the folds, seams of clothes, especially at the belt, collar, cuffs, can take refuge in stockings, in the holes of beads, belt buckles and other decorations, and lays eggs in the same place and from there periodically crawls out onto the body for nutrition.

In a minute, a louse crawls 30-35 cm along the ground and up to 1 m along a vertical surface. Lice can swim, but they cannot jump or fly. Therefore, infection occurs through close contact with affected people, as well as through the exchange of hats, scarves, underwear, etc.

Signs of infection I – itching and multiple scratching on the skin of the trunk: more often on the abdomen, shoulder blades, lower back, thighs, back of the head.

Rash on the body with body lice:

Skin lesions with prolonged course of clothes lice

Body lice

WARNING! If head lice is found, you should feel free to contact the health workers at your place of residence.

Simple and affordable ways to control lice at home:

1. If lice are found, it is necessary to soak underwear and bed linen for 2-3 hours in warm water, and then boil it.

WARNING! Washing without boiling will not kill lice eggs.

2. Clothes that cannot be boiled should be ironed with a hot iron through a damp cloth.

REMEMBER! Pay particular attention to the processing of seams, folds, belts, collars, where the louse lays nits.

3. It is also necessary to iron the bedding (blankets, mattresses and pillows).

The most effective treatment of things, bedding in disinfection chambers, where lice and nits die under the influence of high temperature. The processing of things, bedding in disinfection chambers can be carried out at the City Center for Disinfection and Sterilization (P. Brovki str., 11).

4. It is recommended to clean upholstered furniture with a brush dampened with detergent.The apartment must be thoroughly cleaned.

5. All family members should shower with soap and a washcloth.

Reference: there is an opinion that head lice can suddenly get sick, for example, from the experience of stress. This assumption has no basis. A person cannot be a carrier of the parasite , it is not a microbe or a virus that can be activated under certain circumstances.

ALWAYS HAS A FACT OF INFECTION!

To avoid lice infestation it is recommended:

• observe the rules of personal and public hygiene;
• Examine all family members (scalp, trunk skin, seams, folds, belts, clothing collars) once every 7-10 days;
• not to use other people’s clothes, hats;
• to keep the furnishings and living quarters clean, preventing the accumulation of dirty linen, clothes, garbage, unnecessary items;
• ventilate and knock out (wash, etc.)from dust once a month bedding (pillows, blankets and mattresses).

Observing hygienic skills, carrying out individual prophylaxis, examining the child and relatives for head lice, you will prevent its occurrence in your family.

Be healthy!

City Disinfection and Sterilization Center

Minsk, st. P. Brovki, 11, tel. 290-75-67, 292-04-92

Operating mode: daily from 8.