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.

Secondary data analysis of intertrigo in hospital and geriatric settings: a comparison of prevalence, anatomical locations, and interventions.

BACKGROUND: Skin conditions and dermatological diseases (eg, intertrigo) in older patients are common in clinical practice. In addition to the negative impact on the patient's health, diseases such as intertrigo place a financial burden on the health care system. PURPOSE: The purpose of this secondary data analysis was to compare the prevalence, anatomical locations, and applied interventions of intertrigo in patients in hospitals and geriatric institutions. METHODS: The authors report the outcome of a secondary data analysis of data collected from 2012 to 2016 from the Nursing Quality Measurement 2.0. This is an annually conducted cross-sectional multicenter study. Descriptive statistics and statistical tests were used to analyze the data. RESULTS: Of patients in the hospital, 2.4% (n = 15,152) had intertrigo compared with 3.4% (n = 3743) of patients in geriatric institutions. In general, expert consultation was the least used intervention for the treatment of intertrigo in hospitals (6.1%, n = 359) and geriatric institutions (9.8%, n = 122). CONCLUSION: Independent of the setting, considering the worldwide climate change, the authors expect that the number of patients with intertrigo will be increasing. Therefore, they highly recommend implementing standardized skin assessments for moisture-associated skin damage to identify intertrigo as early as possible. Moreover, as the consultation of experts was seldom used in both settings, advances in the interdisciplinary and interprofessional management of moisture-associated skin damages are needed.

Prevalence and associated factors of intertrigo in aged nursing home residents: a multi-center cross-sectional prevalence study.

BACKGROUND: In geriatric and long-term care settings, intertrigo seems to be common, but generalizable epidemiological estimates are lacking. Aim of this study was to measure the prevalence of intertrigo in aged nursing home residents and to identify possible relationships with demographic and health characteristics. METHODS: A cross-sectional prevalence study was conducted between September 2014 and May 2015 in a random sample of ten institutional long-term care facilities in Berlin, Germany. In total 223, aged long-term care residents were included. Mean age was 83.6 (SD 8.0) years and mean Barthel score was 45.1 (SD 23.8). Board certified dermatologists and study assistants performed skin assessments and measurements according to standard operating procedures. Mean differences and odds ratios between residents with and without intertrigo were calculated. RESULTS: The prevalence of intertrigo was 16.1% (95% CI 11.6 to 21.2%). The submammary fold was most often affected (9.9%), followed by the inguinal region (9.4%), axilla (0.5%) and abdominal region (0.5%). Increased age was statistically significantly associated with the presence of intertrigo (OR 1.05; 95% CI 1.00 to 1.10). Care dependency in bathing activities was associated with intertrigo. Obesity, sex and skin functional parameters were not associated with intertrigo. CONCLUSIONS: Every sixth nursing home resident was affected by intertrigo indicating the high load of this skin condition in this population. Older age seems to be associated with intertrigo. Care dependency in bathing activities was likely to be associated with intertrigo. Structured skin care regimens are needed to prevent and treat intertrigo in this population. TRIAL REGISTRATION: This study is registered at https://clinicaltrials.gov/ct2/show/NCT02216526 . Registration date: 8th November 2014.

Pearls of Neonatal Intertrigo in Ancient Greek and Byzantine Medicine.

OBJECTIVE: Confirmation of knowledge of neonatal intertrigo in ancient Greek and Byzantine medicine. METHOD: A search of Thesaurus Linguae Graecae was conducted with the following terms as key words, "syggama", "xyggauma", "paratrimma" and "ektrimma". RESULTS: Ancient Greek medico-philosophers introduced therapeutic measures based upon herbs and minerals, while a similar therapeutic approach was also used by the Byzantines. Hippocrates of Kos (460-377) was among the first to introduce written instructions, also proposing preventive treatment with palliative and aromatic herbs. Cataplasms, thalassotherapy, and fumigation were used, combined with hygienic measures in the affected area. Chalk powder was also prescribed to absorb moisture. CONCLUSION: The main principles in the treatment of intertrigo remain the same, celebrating the ancient Greeks' methodology and rationalism.

Darier disease: A fold (intertriginous) dermatosis.

Darier disease, also known as Darier-White disease, is characterized by yellow to brown, oily keratotic papules and plaques in the seborrheic areas of the face and chest. This disorder may show different clinical manifestations, such as palmoplantar pits and nail abnormalities. The trigger factors are mechanical trauma, heat, humidity, ultraviolet B, and pyogenic infections. The disease usually becomes apparent in the second decade of life. The ATP2 A2 (SERCA2) gene mutation was detected in all patients. Histopathologic changes include epidermal adhesion loss, acantholysis, abnormal keratinization, eosinophilic dyskeratotic cells in the spinous layer known as corps ronds, and the presence of grains in the stratum corneum. Although the treatment for Darier disease is unsatisfactory, some relief has been achieved with the use of corticosteroids and retinoids.

Hailey-Hailey disease: A fold (intertriginous) dermatosis.

Hailey-Hailey disease, also called benign familial pemphigus, is a late-onset blistering disorder that affects the flexures. There are typically painful erosions and cracks in affected areas. Lesions generally begin between 20 and 40 years of age. In two third of all cases, positive family history is detected. In pathogenesis, there is a defect in keratinocyte adhesion due to ATP2 C1 gene mutation. The result of the desmosomal decomposition is acantholysis. Menstruation, pregnancy, skin infections, physical trauma, excessive sweating and exposure to ultraviolet radiation are important triggering factors. Histopathologic changes are suprabasal acantholysis and formation of intraepidermal bullae. In the epidermis, a partial acantholysis that looks like broken bricks is observed.

Acanthosis nigricans: A fold (intertriginous) dermatosis.

Acanthosis nigricans (AN) is a mucocutaneous disorder that is characterized by focal or diffuse hyperkeratotic, surfaces, which are symmetrically distributed hyperpigmented lesions of the skin. It rarely affects mucosal surfaces like oral cavities. Although it is commonly seen in adolescents, AN is also increasingly seen in children who are obese. Recent studies have found that AN can be a cutaneous indicator of insulin resistance and malignancy. Acanthosis nigricans has been associated with type 2 diabetes mellitus, obesity, endocrinopathies, drugs, and malignancies.

A randomised trial of honey barrier cream versus zinc oxide ointment.

In this single-blind multicentre, intervention study, 31 patients with symmetrical intertrigo in large skin folds were included to study the clinical effect of two topical treatments, i.e. standard therapy with zinc oxide ointment versus honey barrier cream. Patients were treated twice daily for 21 days, and the severity of intertrigo was scored in an observation period of 21 days. Patients were used as their own controls by treating symmetrical skin folds, on the left and right side. There was no significant difference in treatment effect between intervention groups. For the majority of patients, both treatments were effective. However, the use of honey barrier cream showed lower pruritus complaints (12.9% versus 29.0%). Honey barrier cream is a suitable alternative in the treatment of intertrigo, and promotes patient comfort.

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.

Intertrigo and common secondary skin infections.

Intertrigo is inflammation of skinfolds caused by skin-on-skin friction. It is a common skin condition affecting opposing cutaneous or mucocutaneous surfaces. Intertrigo may present as diaper rash in children. The condition appears in natural and obesity-created body folds. The friction in these folds can lead to a variety of complications such as secondary bacterial or fungal infections. The usual approach to managing intertrigo is to minimize moisture and friction with absorptive powders such as cornstarch or with barrier creams. Patients should wear light, nonconstricting, and absorbent clothing and avoid wool and synthetic fibers. Physicians should educate patients about precautions with regard to heat, humidity, and outside activities. Physical exercise usually is desirable, but patients should shower afterward and dry intertriginous areas thoroughly. Wearing open-toed shoes can be beneficial for toe web intertrigo. Secondary bacterial and fungal infections should be treated with antiseptics, antibiotics, or antifungals, depending on the pathogens.

Preventing and treating intertrigo in the large skin folds of adults: a literature overview.

Intertrigo is an inflammatory dermatosis of the skin folds of the body, for which a large variety of topical medications may be recommended. A systematic literature review was performed to find scientific evidence for preventing and treating intertrigo within the nursing domain. Seven electronic databases were searched with a simple broad-scope search strategy. The aim was to identify all publications that concerned intertrigo itself and other conditions that were related to intertriginous regions. This search produced 451 references. A final set of 24 studies was retained and analyzed on content and methodologic quality. Most studies concerned treatments with antifungals or disinfectants in heterogeneous research samples, with only small subsamples of people with intertrigo. Six studies were randomized controlled trials. In general, the methodologic quality of the studies was poor. The analyzed studies provided no scientific evidence for any type of nursing prevention or treatment strategy. There is a great need for well-designed clinical studies on intertrigo.

Intertrigo: a practical approach.

Although the precise diagnosis of intertriginous dermatosis is hampered by the unique conditions of the skin folds, there are a few common rules to be considered in the therapeutic approach. Dryness must be reached by changing occlusive conditions, astringent compresses, and absorbing powders. To improve the primary dermatosis, superimposed infection must be treated. With rare exceptions, fluorinated steroids should not be used in occlusive areas. Finally, the skills of a dermatologist may be required to optimize the care of patients with complex dermatoses involving the flexural skin.