Intertrigo

Overview

What is intertrigo?

Intertrigo is a common inflammatory skin condition that is caused by skin-to-skin friction (rubbing) that is intensified by heat and moisture. It usually looks like a reddish rash. Trapped moisture, which is usually due to sweating, causes the surfaces of your skin to stick together in your skin folds. The moisture increases the friction, which leads to skin damage and inflammation.

In many cases of intertrigo, damage to the skin allows bacteria and/or fungus normally present on the surface of your skin to overgrow. The warmth, trapped moisture and friction-induced skin damage create an ideal environment for bacteria and fungi to grow and multiply. This overgrowth of bacteria and/or fungi triggers your immune system to respond, which results in secondary inflammation and a visible rash. In more severe cases, the bacterial and/or fungal overgrowth is significant enough to cause a secondary infection.

Is intertrigo a fungal infection?

Intertrigo itself is not an infection. It’s an inflammatory skin condition. However, intertrigo often leads to a fungal or bacterial infection. This is known as a secondary infection. Candida — a type of yeast, or fungus — is the most common cause of secondary infection related to intertrigo.

What parts of the body get intertrigo?

Intertrigo can appear in between any skin areas that are in close contact with each other, such as skin folds, and that are often moist.

The most common places that intertrigo occurs include:

  • In the crease(s) of your neck.
  • In your armpits.
  • Beneath or between your breasts.
  • Between your belly folds.
  • Between your buttocks.
  • In your groin at your scrotum.
  • In your inner thighs.
  • Between your toes and fingers.

Babies are especially at risk for intertrigo because their skin is delicate and they’re more likely to have moist skin from drooling or from wearing diapers. The most common places for babies to have intertrigo include:

  • On their buttocks or in their groin area (often referred to simply as diaper rash).
  • In between their neck folds.
  • In the creases of their skin rolls or folds on their arms and legs.

Are there different kinds of intertrigo?

There are a few names for intertrigo (also known as intertriginous dermatitis) depending on certain factors such as where it appears and if it’s caused an infection or not. Your healthcare provider may use one or more of these terms to describe your intertrigo:

  • Acute intertrigo: If your intertrigo just recently appeared, it’s called acute intertrigo.
  • Recurrent intertrigo: If you’ve had multiple cases of intertrigo over time, it’s called recurrent (relapsing) intertrigo.
  • Chronic intertrigo: If your case of intertrigo has lasted six weeks or more, it’s called chronic intertrigo.
  • Uncomplicated intertrigo: Uncomplicated intertrigo means your intertrigo has not caused an infection.
  • Interdigital intertrigo: Intertrigo between your fingers or toes is called interdigital intertrigo.
  • Candidal intertrigo: Candidal intertrigo happens when your intertrigo becomes infected by the yeast (fungus) Candida. Candida is the most common cause of intertrigo infections.
  • Diaper rash: Also known as diaper dermatitis, diaper rash is a form of intertrigo.

Can intertrigo spread to other parts of my body?

You can have intertrigo in more than one place on your body at the same time, but intertrigo does not spread to other parts of your body. This is because a key contributing factor for intertrigo is friction from skin-to-skin rubbing, so only places on your body where your skin rubs together can have intertrigo.

If you get an infection from your intertrigo, the infection can spread to other parts of your body and can cause serious complications. It’s important to see your healthcare provider as soon as possible if you have signs of an infection.

Who gets intertrigo?

Anyone at any age can get intertrigo. Babies often get diaper rash (diaper dermatitis), which is a form of intertrigo. People who have obesity, diabetes and/or a weakened immune system due to underlying disease or medication are more likely to get intertrigo.

How common is intertrigo?

Intertrigo is a common skin condition. It’s most common in hot and humid environments and during the summer.

Symptoms and Causes

What causes intertrigo?

Intertrigo is caused by skin-to-skin friction that is made worse by heat and moisture. This most commonly happens between skin folds or creases and between your toes or fingers.

The trapped moisture — often due to sweating — causes your skin surfaces to stick together. This increases the friction between your skin surfaces, which causes skin damage, bacterial and/or fungal overgrowth and inflammation. In many cases of intertrigo, the skin breaks open from the friction, which allows bacteria and/or fungus to get into your skin, causing an infection. The moisture and warmth make a perfect environment for bacteria and fungi to multiply. If the affected area comes in contact with sweat, pee or poop, it can make your intertrigo worse.

Different kinds of fungi and bacteria that can cause secondary infections include:

  • Candida: Candida, a type of yeast and fungus, is the most common cause of secondary infections in intertrigo cases.
  • Dermatophytes: Dermatophytes are fungi that require keratin (a type of protein) for growth. These fungi can cause infections in your skin and nails. Dermatophyte fungi often cause secondary infections from intertrigo in between your fingers or toes.
  • Staphylococcus aureus: This bacteria — often called staph — is a common cause of intertrigo bacterial infections.

What are the signs and symptoms of intertrigo?

Signs and symptoms of intertrigo depend on how severe it is and if there is an infection or not.

Early symptoms of intertrigo without infection can include:

  • Having a somewhat symmetrical red or reddish-brown rash with small bumps in an area where your skin rubs against itself.
  • Having itching, stinging and/or burning in the affected area.
  • Feeling uncomfortable or experiencing pain in the affected area.

If intertrigo is not treated in its early phase, you can develop the following symptoms:

  • Feeling like your affected skin is raw.
  • Having cracks in your affected skin.
  • Experiencing bleeding or oozing from your affected skin.
  • Having skin that is crusted over and/or scaly in the affected area.

Symptoms of intertrigo with an infection can include:

  • Having a foul smell in the affected area.
  • Having bumps on your affected skin that contain pus.
  • Having raised, tender bumps on your affected skin.

If you have signs of an infection, it’s important to see your healthcare provider or go to the nearest hospital as soon as possible. Infections need proper medical treatment and can lead to serious complications if they’re left untreated.

Is intertrigo contagious?

Intertrigo is not contagious. You can’t get it from another person or spread it to another person.

Diagnosis and Tests

How is intertrigo diagnosed?

Even though intertrigo is a common condition, it can be difficult to diagnose because it can look like other skin conditions that can affect skin folds. Your healthcare provider will ask you thorough questions about your history, focusing on any skin conditions you currently have or have had in the past. They’ll also ask you questions about medications you take, allergies and sensitivities you may have and if you’ve used certain kinds of topical ointments or soaps. They’ll then do a visual examination of your affected skin.

If your provider suspects you have an infection from your intertrigo, they may perform certain tests such as a skin scraping to see what kind of organism is causing the infection.

What tests will be done to diagnose intertrigo?

There’s currently no formal test or assessment tool to diagnose intertrigo. Your healthcare provider will diagnose your intertrigo based on thorough questions about your history and a visual exam of your affected skin.

If your healthcare provider thinks you may have an infection from your intertrigo, they may perform one or more of the following tests:

  • Wood’s lamp examination: A Wood’s lamp is a small tool that uses black light to illuminate areas of your skin. Your healthcare provider will hold the tool over your affected skin in a darkened room. If a certain kind of bacteria or fungi is causing your infection, the light will cause the affected area of your skin to change color.
  • Skin scraping: Your healthcare provider will use a tool to scrape and remove some of your affected skin. They will then look at the skin sample under a microscope to see what kind of fungus or bacteria is causing your infection.
  • Skin biopsy: Your healthcare provider will use local anesthesia and a biopsy tool to remove a small piece of your skin. A laboratory technician or a pathologist will then examine it under a microscope to ensure an accurate diagnosis.

Management and Treatment

How is intertrigo treated?

The main way to treat intertrigo that hasn’t caused an infection is by keeping the affected area dry, clean and cool.

Ways you can keep your intertrigo dry, clean and cool at home include:

  • Dry yourself thoroughly with a clean towel after you take a shower. Dry the affected area by patting it with a towel, not rubbing it.
  • Use a fan or a hairdryer on the “cool” setting over the affected area multiple times a day.
  • Wear loose clothing and breathable fabrics, such as cotton.
  • Use a mild antiperspirant (deodorant) in your armpits or under your breasts to minimize sweating.
  • Use a powder drying agent, such as talcum powder, on your affected area. If you use an ointment for your intertrigo, do not use it and powder at the same time. They will create a tacky paste.

Other things you can do to treat uninfected intertrigo include:

  • Use skin barrier creams or anti-chafing gels: Creams or ointments with zinc oxide and/or petrolatum can help reduce friction between your affected skin by creating a barrier.
  • Use fiber skin barriers: Use materials such as clean gauze or cotton to separate the affected skin that is touching can help reduce friction.
  • Use a topical steroid cream: Your healthcare provider may recommend a topical steroid cream to help with inflammation. You can buy mild steroid creams at your local pharmacy without a prescription.
  • Use topical anti-fungal and/or anti-bacterial creams: Your healthcare provider may recommend a topical steroid cream to help combat fungal and bacterial overgrowth that contributes to inflammation. You can buy anti-fungal and anti-bacterial creams at your local pharmacy without a prescription.

Treatment for intertrigo that has caused an infection depends on what caused it. Your healthcare provider will need to find out what kind of bacteria or fungi have caused your infection in order to give you proper treatment.

Treatment for infected intertrigo can include:

  • Antifungal cream: If you have an infection that’s caused by a fungus, your healthcare provider may have you use a specific topical antifungal cream or ointment on the affected area.
  • Antibiotic cream: If you have an infection that’s caused by bacteria, your provider may have you use a specific topical antibacterial cream or ointment on the affected area.
  • Oral medication: Your provider may prescribe you one or more oral medications (pills) in order to treat your infection. These could include antibiotics or antifungal medications.

Prevention

What are the risk factors for getting intertrigo?

Risk factors for getting intertrigo include:

  • Obesity: Intertrigo is strongly associated with having obesity. People who have obesity usually have more pronounced skin folds and increased sweating. It can also be more difficult for people with obesity to properly clean and care for their skin folds.
  • Diabetes: Having diabetes can cause increased sweating, which helps contribute to intertrigo. In addition, having diabetes and chronic high blood sugar can increase your skin surface pH, which makes it more ideal for bacteria and fungi to grow and multiply. This can put people with diabetes at a higher risk of getting an infection from intertrigo.
  • Incontinence: People who have urinary incontinence (not being able to control their bladder) and/or fecal incontinence (not being able to control their bowel movements) are at higher risk for intertrigo because pee and/or poop in an absorbent undergarment creates a warm and moist environment. If you already have intertrigo, contact with sweat, pee or poop can make your intertrigo worse.
  • Excessive sweating: Excessive sweating (known as hyperhidrosis) can put you at a higher risk of intertrigo.
  • Excess skin from significant weight loss: People who have excess skin from significant weight loss are more likely to get intertrigo due to the skin folds rubbing together.
  • Living in a hot and humid environment: Intertrigo is caused by skin friction due to trapped moisture, so living in a hot and humid environment, where you are more likely to sweat, puts you at a higher risk of getting intertrigo.
  • Your age: Intertrigo is more common in babies and older people. Babies are at a higher risk for intertrigo because their skin is sensitive and they often have moist skin from drooling or from wearing diapers. It can be more difficult for older people to bathe and care for their skin routinely, so they’re at a higher risk for intertrigo.

What can I do to prevent intertrigo?

There are several things you can do to try to prevent getting intertrigo, including:

  • Keep your skin cool, dry and clean, especially areas where your skin rubs together.
  • Shower and dry off completely every day and especially after you exercise or sweat.
  • Avoid wearing tight clothes or shoes.
  • Wear clothes that are made of breathable and absorbent fabrics, such as cotton, and avoiding clothes made of synthetic materials.
  • Use a skin barrier protectant cream if you have incontinence.
  • Change your child’s diaper frequently to prevent diaper rash (a form of intertrigo).

If you’ve had repeated cases of intertrigo, the following actions may help to prevent future cases:

  • Have a structured skincare routine: Talk to your healthcare provider or a dermatologist about a skincare routine that could help prevent intertrigo. The plan could include gentle cleansing, moisturizing and using a skin barrier protectant such as zinc oxide or petroleum jelly.
  • Lose weight: If you have obesity, losing weight could help prevent future cases of intertrigo. See your healthcare provider and/or a registered dietician to discuss ways you can healthily and safely lose weight.
  • Have a breast reduction: If you’ve had cases of intertrigo under your breasts, a breast reduction could help. Talk to your healthcare provider.
  • Have body contouring surgery: If you’ve had cases of intertrigo due to having excess skin from significant weight loss, talk to your provider about body contouring surgeries, such as tummy tuck (abdominoplasty) and brachioplasty, to remove extra skin.

Outlook / Prognosis

What is the outlook for intertrigo?

While intertrigo can be unpleasant and painful, it is treatable. The prognosis (outlook) for intertrigo depends on the person’s overall health. In most cases, people recover well from intertrigo if it’s treated properly.

Intertrigo can become chronic (long-lasting) or recurrent (occurring often), so it’s important to take care of yourself and follow a proper hygiene routine to prevent your intertrigo from coming back.

Can intertrigo cause complications?

If intertrigo is not treated properly, it can cause complications, including:

  • Nail fungal infections: If a fungal infection from intertrigo that is between your toes or fingers is not treated properly, it can cause a fungal infection in your toenails or fingernails.
  • Cellulitis: Cellulitis is a deep infection of the skin and soft tissue caused by bacteria. If cellulitis is not treated properly, it can be life-threatening. This complication is more common in people who have diabetes and intertrigo.
  • Sepsis: If you have an infection caused by intertrigo that is not treated, it could lead to sepsis. Sepsis is a medical emergency caused by the body's response to systemic infection. It can be life-threatening.

Living With

When should I see my healthcare provider?

If you have a skin rash that isn’t going away or suddenly gets worse, it’s important to see your healthcare provider. There are many different kinds of skin rashes — many of which look very similar —so your provider will want to make sure your rash is in fact intertrigo and not something else.

If you have been diagnosed with intertrigo and your intertrigo doesn’t seem to be getting better with treatment, contact your healthcare provider.

If you have signs of an infection from your intertrigo — such as a foul smell in the affected area or pus—be sure to see your healthcare provider as soon as possible or go to the nearest hospital. Infections need proper medical treatment.

If you’ve had multiple cases of intertrigo over time (recurrent intertrigo), talk to your healthcare provider about how you can prevent it from coming back and more permanent solutions for prevention.

A note from Cleveland Clinic

While intertrigo can be unpleasant and painful, the good news is that it’s treatable and often preventable. Try your best to prevent intertrigo by keeping your skin clean, dry and cool, especially if you’re at a higher risk of getting it. If you have symptoms of intertrigo, be sure to contact your healthcare provider. You will receive a proper diagnosis and a treatment plan so that you can feel better soon.

Last reviewed by a Cleveland Clinic medical professional on 08/24/2021.

References

  • Kalra MG, Higgins KE, Kinney BS. Intertrigo and Secondary Skin Infections. (https://www.aafp.org/afp/2014/0401/p569.html) American Family Physician. 2014; 89(7): 569-573. Accessed 9/7/21.
  • Nobles T, Miller RA. Intertrigo. (https://www.ncbi.nlm.nih.gov/books/NBK531489/) StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2021. Accessed 9/7/21.
  • Voegeli D. Intertrigo: causes, prevention and management. (https://pubmed.ncbi.nlm.nih.gov/32579453/) British Journal of Nursing. 2020; 29(12): 16-22. Accessed 9/7/21.

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