What Is Intertrigo?

Intertrigo is an inflammatory rash that develops between skin folds, such as the armpits, groin, and under the breasts. A combination of moisture, lack of airflow, and friction where skin rubs together causes intertrigo.

Intertrigo is treatable, and it’s important to identify and address the underlying cause to prevent the rash from recurring. Treatment is especially important because of the risk of infection. Irritated and inflamed skin combined with warmth and moisture provides the ideal environment for bacteria and fungi to grow and thrive. This can lead to a skin infection and worsen the rash.

While intertrigo is most common in people with obesity, diabetes, and limited mobility, anyone can develop it. Being able to recognize intertrigo so you can get the care you need is key—as is knowing how to prevent the rash in the first place.

Intertrigo Symptoms 

Intertrigo often shows as well-defined patches of a bright red rash. The patches may be raised. The affected area may be itchy, and you might also feel burning, tingling, and pain.

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Intertrigo can develop anywhere skin rubs together or traps moisture. This includes bends and folds around the body. The rash most commonly affects the following areas:

• Armpits
• Groin
• Between toes 
• Under the breasts 
• Neck creases 
• Abdominal skin folds 
• Between the buttocks 
• Back of the knees 

If intertrigo is left untreated, the skin can begin to break down due to moisture and friction. This can lead to symptoms like bad odor, cracked skin, and bleeding.

What Causes Intertrigo? 

Intertrigo is caused by skin-on-skin friction within warm, damp, poorly ventilated places on the body. The combination of skin chafing and moisture irritates and inflames the skin, leading to intertrigo.

The explanation as to why intertrigo develops is actually in the Latin name itself—inter translates to between and terere translates to to rub.

Risk Factors

Intertrigo is most common among people with obesity. This is due to the more pronounced skin folds as well as higher body temperature.

Other medical conditions that can increase your risk of having intertrigo include diabetes and urinary or bowel incontinence. Having a weakened immune system, such is the case with HIV, can also put you at greater risk. If you have a medical condition that makes you unable to move, you can be at risk for intertrigo.

Wearing a diaper or a medical device like artificial limbs, braces, and splints can be a risk factor since these all trap moisture on the skin.

Where you live can also impact how likely it is that you develop intertrigo. The condition is more common in hot, humid climates.

And while someone of any age can get intertrigo, it may be most common among infants and older adults.

How Is Intertrigo Diagnosed?  

Healthcare providers can diagnose intertrigo just by looking at your rash. Your healthcare provider will likely also ask about your symptoms and risk factors for intertrigo.

Sometimes, healthcare providers may order diagnostic tests to rule out other skin conditions or determine if the affected area is infected.

This might include a KOH test. For this test, your healthcare provider will scrape a small area of the affected skin with a needle or scalpel blade. The skin sample is examined under a microscope in the lab to check for signs of a fungal infection.

They might also perform a skin culture. For this, your healthcare provider will collect cells from the affected area using a cotton swab. The cells are placed in a special dish and examined under a microscope to see if fungi or bacteria grow.

Treatments for Intertrigo  

Intertrigo treatments focus on reducing friction, moisture, and warmth in skin folds to relieve symptoms and promote healing. Treatment options for intertrigo vary depending on the severity of the rash and whether or not it is infected. 

Self-Care Measures

Keeping the affected area clean and dry is an essential aspect of intertrigo treatment. At-home measures that can help treat intertrigo include: 

• Bathing or showering after any physical activity that causes you to sweat a lot
• Drying off your body with a soft towel after a shower or bath
• Separating your skin folds with dry towels
• Wearing loose, moisture-wicking clothing
• Working in air-conditioned environments
• Blowing a fan on moist areas of your body
• Changing your position routinely if you cannot move and are in a bed

Over-The-Counter Topical Treatment

You can also apply certain products to your skin to improve your intertrigo. These can include barrier agents and drying agents.

Barrier agents can reduce any skin breakdown and help with itchiness and pain. This can include skin protectants like zinc oxide ointment and petrolatum. You can also use cotton or other absorbent material to separate folds and reduce friction.

Drying agents can keep the area moisture-free. Antiperspirants can minimize the moisture between the folds. This can include aluminum sulfate and calcium acetate solution.

Prescription Medication

If intertrigo doesn’t go away with self-care or over-the-counter measures, you might be prescribed a low-dose steroid, like hydrocortisone cream, to bring down some of the inflammation.

If the affected area develops a fungal or bacterial infection, you may be prescribed an antifungal or antibacterial to clear the infection. These medications may be either topical or oral. A common topical antifungal is Lotrimin (clotrimazole), while a common topical antibacterial is Baciguent (bacitracin).

Antifungals or antibacterials should be taken in addition to a drying agent. However, you should not apply an antifungal at the same time as a drying agent because the combination will turn into a sticky paste. Instead, use them two or three hours apart.

How To Prevent Intertrigo 

The best way to prevent intertrigo is to keep skin folds clean and dry. Other intertrigo prevention strategies include: 

• Practice good personal hygiene, including daily bathing or showering and changing your clothes and undergarments regularly. 
• Dry your skin after bathing, showering, or sweating. 
• Wear loose-fitting, breathable clothing.
• If you have obesity, manage your weight so you decrease the amount of friction and moisture in skin folds.

Complications 

Without treatment, intertrigo can worsen and lead to complications. Possible complications of intertrigo include: 

• Secondary infection: It is common for the skin affected by intertrigo to be infected by bacteria and Candida yeast or other fungi. The warm, damp space within skin folds creates an ideal environment for the microorganisms. You might also develop a more severe bacterial infection called cellulitis.
• Skin breakdown: Moisture and friction can cause breakdown of the skin. Intertrigo that goes unnoticed may lead to open sores, or ulcers. Ulcers that aren't caught and treated can then lead to sepsis, a dangerous condition where your body doesn't respond correctly to an infection.
• Recurrent or chronic intertrigo: Intertrigo may become recurrent or chronic if left untreated or underlying causes are not addressed.
  

Early diagnosis and treatment of intertrigo can help prevent complications and promote healing.

A Quick Review

Intertrigo is an inflammatory rash that affects the folds of the skin, such as the armpits, groin, and under the breasts. A combination of moisture, friction, and heat in these areas can lead to red, irritated skin and itching or burning sensations in the affected area. In severe cases, intertrigo may cause the skin to crack or to have an odor. Secondary bacterial or fungal infections are common and can develop within the skin folds if intertrigo is left untreated. 

See a healthcare provider if you have symptoms of intertrigo. Treatment can help clear the rash; cure any secondary infection you might have; and soothe irritated, inflamed skin. Depending on the severity of the rash, healthcare providers may recommend self-care, topical creams or ointments, or oral medications to treat intertrigo. You can lower your risk of intertrigo by keeping your skin clean and dry; wearing loose-fitting, moisture-wicking clothing; and managing underlying health conditions associated with an increased risk of intertrigo, such as obesity and diabetes.