Intertriginous dermatitis (ITD), also referred to as intertrigo, is an inflammatory condition that affects opposing skin surfaces and can occur anywhere on the body where two surfaces are in contact. For example, the pannus or abdominal skin folds, inner gluteal cleft, and axillae are some common anatomical locations of ITD.

Intertrigo is seen across care settings and is increasingly common in patients with diabetes, patients with obesity, and patients who need assistance with hygiene or self-care activities of daily living. ITD is thought to be caused by a combination of two factors: moisture trapping or overhydration of the skin and friction between opposing skin folds (skin rubbing against skin for a prolonged period of time). ITD may manifest as a linear tear at the base of a fold or a linear open area within an area of macerated skin. Tears may result from stretching of overhydrated or moist skin during routine skin assessments or from friction with cleansing.¹

Risk Factors and Prevention Methods for Intertriginous Dermatitis

Risk Factors

Some common risk factors for ITD include¹:

• Obesity
• Diabetes
• •Impaired mobility or function (patients who need help bathing, cleaning, dressing, etc.)
• •Reduced perfusion (common in adipose tissue)
• •Administration of antibiotics and steroids together

Prevention

Prevention should be the priority with ITD. Prevention methods include¹:

• Keeping skin folds clean and dry (meticulous hygiene especially in the presence of diaphoresis; evidence recommends using a pH-balanced cleanser and soft cloth or a pre-moistened, no-rinse cloth for skin fold hygiene, followed by patting dry)
• Wearing loose-fitting clothing
• Using friction-reducing measures

Diagnosis, Clinical Manifestations, and Complications of Intertriginous Dermatitis

An early indicator of ITD is mild erythema, usually within a skin fold; the inguinal region, the inframammary region, and the neck folds of infants (trapped moisture from drooling) are common locations. Untreated, this condition may progress to severe inflammation, mirrored areas of tissue loss or skin erosion, or linear fissure formation. The open areas caused by ITD are typically partial-thickness ulcers. Patients with ITD may report pain, odor, itching, or burning. Overhydrated or macerated skin may become inflamed and denuded, posing a risk for candidiasis or another fungal infection. If ITD is not well managed, there is also risk for bacterial infection, including cellulitis, or panniculitis. Complications may also include secondary infections such as streptococcal, staphylococcal, and antibiotic-resistant infections.¹

Treatment

Treatment begins with a comprehensive history and assessment, including thorough head-to-toe skin assessment, focusing on skin folds. Skin hygiene measures should emphasize minimizing moisture, friction, and additional skin irritants in high-risk areas. Moisture wicking fabrics or textiles can also be helpful. ITD accompanied by fungal infection may warrant treatment with a topical antifungal medication. Oral antifungals may be considered in resistant fungal infections, but some of these agents may potentiate the effects of hypoglycemic agents and lead to hypoglycemic episodes; therefore, patients with diabetes should monitor their blood glucose closely with concomitant use of oral medications.¹

Conclusion

Some key points to take away from this blog are:

• The best management strategy is prevention.
• Keep skin folds clean and dry with meticulous hygiene.
• Pursue aggressive risk factor modification as able (healthy diet or weight control, diabetes management).
• Perform moisture wicking measures and provide separation of skin folds to prevent damage from forces of friction.
• Perform frequent and thorough skin assessments, focusing on skin folds and implementing appropriate prevention or treatment measures early.

ITD impacts many aspects of life, from body image, to pain, odor, clothing and appearance, and overall quality of life. As mentioned, the best management strategy is prevention, as well as early treatment of signs of mild erythema area noted within skin folds. Follow-up with a provider and/or skin or wound specialist may be warranted if the issue persists despite initial treatment and prevention recommendations to prevent a secondary infection, progressive skin condition, or deeper wound.

Reference

1. Thayer D, Rozenboom B, LeBlanc K. Prevention and management of moisture-associated skin damage (MASD), medical adhesive-related skin injury (MARSI) and skin tears. In: McNichol LL, Ratliff CR, Yates SS, eds. Wound, Ostomy and Continence Nurses Society Core Curriculum: Wound Management. 2nd ed. Philadelphia, PA: Wolters Kluwer; 2022:323-354.

About the Author

Holly is a board certified gerontological nurse and advanced practice wound, ostomy, and continence nurse coordinator at The Department of Veterans Affairs Medical Center in Cleveland, Ohio. She has a passion for education, teaching, and our veterans. Holly has been practicing in WOC nursing for approximately six years. She has much experience with the long-term care population and chronic wounds as well as pressure injuries, diabetic ulcers, venous and arterial wounds, surgical wounds, radiation dermatitis, and wounds requiring advanced wound therapy for healing. Holly enjoys teaching new nurses about wound care and, most importantly, pressure injury prevention. She enjoys working with each patient to come up with an individualized plan of care based on their needs and overall medical situation. She values the importance of taking an interprofessional approach with wound care and prevention overall, and involves each member of the health care team as much as possible. She also values the significance of the support of leadership within her facility and the overall impact of great teamwork for positive outcomes.