EpistemisIntertrigo
Specialty: Skin.
Why it occurs
- Colonization and superinfection by yeasts of the genus *Candida albicans* in humid skin environments
- Repeated mechanical skin-to-skin friction in overweight or obese patients
- Infection by gram-positive bacteria such as *Corynebacterium minutissimum* (erythrasma, characterized by coral red fluorescence under Wood's light)
- Inverted psoriasis (well-defined, smooth and shiny erythematous plaques in folds, without peeling)
- Contact dermatitis due to deodorants, perfumes or friction from shoes/clothing.
Initial workup
Skin scraping and direct examination with KOH to confirm the presence of candida hyphae and pseudohyphae. Wood light examination to rule out erythrasma (coral red glow) or pseudomonas (greenish glow). Bacteriological and mycological culture if the lesions do not respond to the initial standard treatment.
red flags
Presence of rapidly spreading erythema that exceeds the fold with acute pain, heat and local swelling (suspected invasive bacterial cellulitis), or appearance of severe generalized peeling with fetid exudate or focused tissue necrosis in immunosuppressed patients or decompensated diabetics.
Standard management
- Miconazole 2% cream — broad-spectrum imidazole antifungal applied 2 times a day for 2 weeks in case of candidiasis
- Hydrocortisone 1% combined cream — applied for a short time, maximum 5 days, to relieve intense erythema and pruritus
- Inert desiccant powders with zinc oxide — designed to absorb residual moisture and reduce mechanical friction
- Topical erythromycin 2% gel (treatment of choice if erythrasma due to corynebacterium is confirmed).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Skin
- Listed causes
- 5
- Treatment options
- 4