Vulva Intertrigo

Intertrigo

This is a mechanical inflammatory dermatosis consisting of superficial inflammation in the skin folds where there is friction, heat and moisture.

Pathophysiology: The folds rub together causing redness, maceration, erosion, and fissuring with secondary infection. Infection is usually mixed Candidiasis and bacteria. The typical patient is obese with deep, hot, sweaty skin folds. Poor hygiene, uncontrolled diabetes and psoriatic tendency all contribute.

Clinical: Patients complain of varying degrees of itching, burning or irritation. They note they are worse when it is hot and humid or when they have been wearing synthetic clothing. This is often seen in obese patients, not only in the groin but also under the abdominal pannus, under the breasts and sometimes in the axillae. If these skin folds chronically rub against each other, it can be very difficult to clear this. It may be worse if the patient has a tendency towards psoriasis. Erythema, maceration and fissuring can be quite variable.

Diagnosis is made by observing the clinical pattern. Appropriate culture can isolate yeast or bacteria. Management consists of reversing the causes. Stop the friction. Avoid hot, tight, synthetic clothing. Cleanse gently and pat dry. Hydrocortisone 1% with clotrimazole or miconazole cream, or Nystatin with 1% hydrocortisone. If secondary infection is cultured or even if simply suspected clinically, oral cephalosporin and oral fluconazole. Reculture if resistance seems to be present. An absorbent non-talc dusting powder is helpful. (for example Zeasorb (made from corn) or actual cornstarch or Zeasorb AF with miconazole, OTC).