The diagnosis, management and prevention of intertrigo in adults: a review.

Intertrigo is a common inflammatory skin disorder caused by skin-on-skin friction in skin folds, due to moisture becoming trapped because of poor air circulation. This can occur in any area of the body where two skin surfaces are in close contact with each other. The aim of this scoping review was to systematically map, review and synthesise evidence on intertrigo in adults. We identified a wide range of evidence and performed a narrative integration of this related to the diagnosis, management and prevention of intertrigo. A literature search was conducted within the following databases: Cochrane Library, MEDLINE, CINAHL, PubMed and EMBASE. After reviewing articles for duplicates and relevance, 55 articles were included. The incorporation of intertrigo in the ICD-11 provides a clear definition and should improve the accuracy of estimates. With regards to the diagnosis, prevention and management of intertrigo, the literature demonstrates consensus among health professionals in approach and this forms the basis for the recommendations of this review: identify predisposing factors and educate patient in reducing these; educate patients in skin fold management and adopt structured skin care routine; treat secondary infection with appropriate topical agent; consider using moisture-wicking textiles within skin folds to reduce skin-on-skin friction, wick away moisture and reduce secondary infection. Overall, the quality of evidence on which to determine the strength of any recommendations for practice remains low. There remains the need for well-designed studies to test proposed interventions and build a robust evidence base.

Toe Web Infections, the Microbiome, and Toe Web Psoriasis: A Review.

OBJECTIVE: To present the toe web space as an anatomically, physiologically, and pathologically unique part of the human body; characterize toe web infections and discuss why they occur; and highlight toe web psoriasis as an uncommon condition that providers should consider if toe web intertrigo does not respond to treatment. DATA SOURCE: This review encompassed many years of clinical observation and photographs; medical textbooks; and a literature search of MEDLINE, PubMed, and Google Scholar. STUDY SELECTION: Primary research keywords included intertrigo, toe web intertrigo, toe web infection, tinea pedis, microbiome, skin microbiome, toe web microbiome, ecology, psoriasis, psoriasis microbiome, intertriginous psoriasis, and Wood's lamp. More than 190 journal articles met the search criteria. DATA EXTRACTION: The authors sought data relating to what makes for a healthy toe web space and what makes for disease. They extracted and collated relevant information to compare and contrast among sources. DATA SYNTHESIS: After understanding the normal toe web space and the microorganisms that normally reside there, the authors investigated why infections occur, how they should be treated, what complications may result, and what other diseases occur in the toe web area. CONCLUSIONS: This review of toe web infection illustrates the effect of the microbiome and reports a rare form of psoriasis that is usually misdiagnosed as athlete's foot. The toe web space is a unique part of the human body that can be affected by a variety of both common and unusual conditions.

Incontinence-Associated Dermatitis and Intertriginous Dermatitis as Nurse-Sensitive Quality Indicators: A Delphi Study.

PURPOSE: This purpose of this study was to determine whether consensus exists concerning the need to collect epidemiologic data about 2 forms of moisture-associated skin damage, incontinence-associated dermatitis (IAD) and intertriginous dermatitis (ITD), and whether these data should be part of data routinely collected as part of the National Database of Nursing Quality Indicators (NDNQI). DESIGN: Modified Delphi technique. SAMPLE AND SETTING: Questionnaires were sent via e-mail to 50 identified experts, with an initial response of 17. Thirteen clinical experts responded to the second round and 11 responded to a third round. METHODS: Items on the questionnaires were investigator-developed. Consensus was defined as 80% or more agreement. Three rounds of questionnaires were employed to attempt consensus. Descriptive statistics were performed using mean and standard deviation for continuous data and frequencies and percentages for categorical data. Qualitative data were analyzed question by question by the primary researcher using content analysis. RESULTS: Consensus was achieved indicating that individual facilities should regularly collect data about IAD prevalence or incidence. Consensus was not reached about the need to regularly collect data about ITD prevalence or incidence. Panelists also failed to reach consensus that IAD or ITD prevalence or incidence should be incorporated into the NDNQI indicators. CONCLUSION: Panelists did not reach consensus that IAD or ITD epidemiologic data should be incorporated on the NDNQI. Additional research is needed, particularly in the area of ITD, before benchmarks can be established regarding these data as nurse-sensitive indicators of quality care.

[Etiology of intertrigo in adults: A prospective study of 103 cases]. / Les étiologies des intertrigos chez l'adulte : étude prospective de 103 cas.

INTRODUCTION: The etiologies of intertrigo in adults are numerous and different. The objective of our work was to study the epidemiological, clinical and the risk factors of intertrigo in adults. METHODS: We conducted a prospective study for a period of seven months in two Dermatology Units in Dakar (Senegal). All adults patient with intertrigo seen during this period who gave consent were included. RESULTS: One hundred and three patients with intertrigo were diagnosed with a hospital prevalence of 2.54%. The sex -ratio was 0.63 and the average age was 41. The study of habits and lifestyles of the patients found a history of intensive skin lightening, sport, wearing synthetic clothes and smoking in 26, 22, 20 and 22 cases, respectively. Infectious complications mainly bacterial (3.88%) and viral (1.94%) were reported in nine cases (8.7%). A dry erythroderma was noted in 3 cases (2.9%). It was found that the intertigo was commonly caused by fungal infections with a prevalence of 48.5% followed by immuno-allergic reactions with a prevalence of 34.9%, suppurative hidradenitis and inverse psoriasis with the same prevalence of 2.9%. Fifty-eight percent of cases with tinea and 63% of cases with candidiasis were women. Thirty-five percent of tinea cases and 45% of candidiasis cases were found to have a history of intensive skin lightening. CONCLUSION: The cause of intertrigo in adults are mainly infectious, particularly fungi, infections and immuno-allergic diseases. There are predisposing factors and some professions are more at risk.

Risk Factors for Chronic Intertrigo of the Lymphedema Leg in Southern India: A Case-Control Study.

Rich clinical experiences indicate that toe web intertrigo is a major predisposing condition for cellulitis/acute dermatolymphango adenitis (ADLA) and the number of lesions is the strongest predictor of frequency of ADLA in lymphedema (LE) patients. However, there is scanty information on the risk factors for the establishment of chronic toe web intertrigo in LE patients. We performed a case-control study recruiting 52 lower limb LE with intertrigo and 52 lower limb LE without intertrigo in community settings and assessed general and local potential risk factors for chronic intertrigo. Analysis of local risk factors revealed that topical application of oil, tingling and numbness of the extremities were associated independently with chronic intertrigo. In multivariate analysis, LE grades III and IV were associated with chronic intertrigo, after adjusting for tingling and numbness, prophylactic antibiotic, age group, and gender. From a public health perspective, LE patients of grades III and IV and patients under antibiotic prophylaxis should be self-motivated to look for the early symptoms of toe web intertrigo to prevent chronic stage and recurrent episodes of cellulitis. Patients with history of tingling and numbness of the periphery need to be monitored for pressure effects leading to poor vascularization and delayed healing of intertrigo.

Resistant "candidal intertrigo": could inverse psoriasis be the true culprit?

Inverse psoriasis is a disorder of intertriginous areas of the skin that can easily masquerade as candidal intertrigo. Candidal rashes are commonly encountered in primary care and typically respond promptly to therapy. When treatment fails, nonadherence to treatment and medication resistance often are suspected; however, the possibility of an incorrect diagnosis should also be entertained. This article presents the case of a patient with inverse psoriasis who was misdiagnosed with recurrent candidal intertrigo multiple times. The diagnosis and treatment of inverse psoriasis is reviewed, and other conditions that may be confused with Candida and inverse psoriasis, including bacterial intertrigo, tinea, and seborrheic dermatitis, are discussed. When confronted with a case of "resistant Candida," consideration of inverse psoriasis and other Candida mimics can allow physicians to diagnose and treat these conditions more effectively, avoiding the frustration experienced by our patient.

Desire for post bariatric body contouring in South East Scotland.

The past 20 years has seen a doubling in the worldwide prevalence of morbid obesity (usually defined as a body mass index BMI, >40 kg/m(2)). Scotland has one of the worst obesity records amongst developed countries. In 2010, 65.1% of all adults aged 16 and over were overweight or obese. Morbid obesity rates (BMI 40 kg/m(2) or more) increased from 1.2% in 1995 to 2.7% in 2003, and fluctuated between 2.2% and 2.7% between 2008 and 2010 (Figure 1). Morbid obesity is associated with twice the mortality compared with the general population. The National Audit Office (NAO) estimated that in 1998 over 30,000 deaths a year in England were attributable to obesity, approximately 6% of all deaths in that year. Obesity is associated and with other conditions such as hypertension, type 2 diabetes, cardiovascular disease, osteoarthritis and cancer, as well as increased rates of psychiatric illness.

Dermatitis of the folds in black Africans in Bamako, Mali.

Dermatitis of the folds (intertrigo) is a frequent reason for attending consultations, particularly in Africa, where the hot and humid climate constitute an aggravating factor. It is a complex pathology with multiple and intricate etiologies. The aim of this study was to describe epidemiological and etiological aspects of dermatitis of the folds in black-skinned subjects in Bamako (Mali). We conducted a transversal descriptive survey of cases of localized dermatitis of the folds of the skin in dermatology clinics in Bamako. In total, 141 cases of intertrigo were identified: 96 female subjects (68%) and 45 male subjects. The average age of patients was 30 ± 18 years (2-80 years). The majority of patients were seen between March and June; 52% of patients had already received treatment before the consultation. The lesions affected skin folds of the groin area and/or area between the buttocks in 95 patients (57.4%), and folds of the armpits and area under the breasts were affected in 46 cases (42.6%). Eczema, erythrasma, and fungal disease were the most frequently observed pathologies. Of interest to this study is the topographical approach that a dermatologist must adopt when diagnosing certain forms of dermatitis. In populations with specific cultural practices, apart from a thorough knowledge of these specific factors, treatment of these conditions requires certain harmful attitudes and behaviors to be abandoned.

Skin findings associated with obesity.

We are facing an obesity epidemic in adolescents in the United States. Thus, practitioners will need to become familiar with cutaneous findings associated with obesity in order to diagnose and treat them properly. This article addresses some of the cutaneous findings associated with obesity.

Al Andalus Ultra Trail: an observation of medical interventions during a 219-km, 5-day ultramarathon stage race.

OBJECTIVE: To record the injuries and health problems suffered by ultramarathon runners during a 219-km, 5-day stage race and to help race organizers plan medical provision for these events. DESIGN: Observational study. SETTING: Al Andalus Ultra Trail 2010, in southern Spain. PARTICIPANTS: All 69 ultramarathon runners. MAIN OUTCOME MEASURES: Total numbers and percentages of each clinical encounter with a health professional and their respective health problems. RESULTS: Sixty-nine competitors started the race, and 39 runners were seen with a medical problem (56.5%). There were a total of 99 clinical encounters. The most common reasons for consulting were foot blisters (33.3%), followed by chafing (9.1%). Lower limb musculoskeletal injuries accounted for 22.2%, predominantly affecting the knee. CONCLUSIONS: This is the first report of a multistage ultramarathon race where medical coverage was present throughout and has reported on musculoskeletal, dermatological, and other medical problems. When providing medical coverage for stage events, the medical team needs to promote practices that minimize injury and address both running-related injuries and non-running-related injuries, taking account of environmental conditions.

Intertriginous eruption.

Intertrigo is a superficial inflammatory skin disorder involving any area of the body where two opposing skin surfaces can touch and rub or chaff. The word "intertrigo" comes from the Latin inter (between) and terere (to rub) and reflects the rubbing together of skin against skin to create maceration and irritation, hence, friction dermatitis or chaffing. It is a common disorder that can affect any individual from infancy to old age. It is primarily caused by skin-on-skin friction and is facilitated by moisture trapped in deep skin folds where air circulation is limited. The condition is particularly common in obese patients who have diabetes and who are exposed to heat and humidity. The moist, damaged skin associated with intertrigo is a fertile breeding ground for various microorganisms, and secondary cutaneous infections are commonly observed in these areas. The present chapter does not deal with "ordinary" intertrigo, but rather with other skin diseases that have affinity to the intertriginous areas. Diseases mentioned are: acrodermatitis enteropathica, the baboon syndrome or intertriginous drug eruption, Darier disease, Hailey-Hailey, granular parakeratosis, Kawasaki syndrome, necrolytic migratory erythema, streptococcal intertrigo and others.

[How I treat....A stoutness-associated intertrigo]. / Comment je traite... un intertrigo lié à l'embonpoint.

Intertrigo is a common inflammatory disorder of various origins. It can represent a single skin manifestation or be part of a disorder possibly exhibiting specific manifestations on other parts of the body. Hence, intertrigo may represent a sign of a peculiar disease. It may also result from physicochemical aggressions of the skin following occlusion of the large skinfolds particularly in case of stoutness. In this intance, a treatment similar to that of diaper dermatitis can be offered. A paste enriched or not with miconazole nitrate is indicated to prevent or treat most presentations of intertrigo.

Etiologic and causative factors in perianal dermatitis: results of a prospective study in 126 patients.

BACKGROUND: Perianal dermatitis is probably the most common cutaneous disorder of the genitoanal area. Studies on the epidemiology of causative factors are rare. METHODS: Over a 4-year period we prospectively studied 126 patients with a presumptive diagnosis of anal eczema. The diagnostic algorithm comprised medical history, inspection, microbiology, laboratory chemistry, patch tests, proctoscopy, and biopsy if appropriate. RESULTS: The age range was 7-82 years and the majority of patients were male (57.1%). Periods of anal symptomatology ranged from 6 days to 120 months and most of the patients (51.6%) had complaints for more than 12 months. The clinical diagnosis in 68 patients (54%) was: intertrigo/candidiasis (42.9%), atopic dermatitis (6.3%), pruritus ani (5.6%), psoriasis (3.2%), skin atrophy from steroid use (2.4%), lichen sclerosus et atrophicus (n = 2), herpes simplex (n = 1), and condylomata acuminata (n = 1). Contact eczema was suspected in 58 patients (46%), but 25 of these (43.1%) showed no contact sensitization. CONCLUSION: The majority of patients with symptoms of anal eczema suffer from intertrigo/candidiasis, and relevant, causative contact sensitization may be found in only some of them. Patch-testing is a valuable investigative tool only when the patients' own products are included in the test series. Most patients suffer from their perianal complaints for more than 12 months, therefore diligent evaluation is warranted.