[Intertrigo, with special consideration on perianal, retroauricular and periocular intertrigo].
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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 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.
Biochemical and physiological tests were carried out on the skin surface of 20 patients with candidal intertrigo and 27 patients with tinea cruris. In all patients the test areas were free of efflorescences. The same tests were performed in 39 and 27 resectively healthy test persons of the same age and sex. The following striking findings came to light: 1. There was a significant decrease in the percentage amount of squalene in the skin surface lipids of the moniliasis group as compared with the control group. 2. There was a significant decrease in the reducing substances in the so called water solubles obtained with the phenol sulfuric acid method in the moniliasis group. The same results were obtained when only those moniliasis patients who were definitely not suffering from diabetes mellitus were taken into account. This is presumably a question of a reduction in the bound carbohydrates. 3. There were significantly more amino acids extractable from the skin surface of the tinea cruris patients than of the control persons. These results point to important predisposing factors for the susceptibility to candidal intertrigo and tinea cruris respectively.
HISTORY AND CLINICAL FINDINGS: A 57-year-old man with diabetes and hypertension was treated with amoxycillin, clarithromycin and pantoprazole for a gastric ulcer positive for Helicobacter pylori. On the second treatment day he developed inguinal pruritus with erythema. He presented at out-patient clinic on the 5th day suspected of having Candida intertrigo. He had bright red, relatively well-circumscribed erythema, most marked at the edges, mainly over the inguinal region and the inside of the thigh. There were no other symptoms. INVESTIGATIONS AND DIAGNOSIS: Bacteriological and mycological tests of the affected skin were unremarkable. Immunological tests showed a normal total IgE but were negative in the CAP-FEIA test for penicilloyl G, penicilloyl V, amoxycilloyl and ampicilloyl. An epifocal epicutaneous test with amoxycillin and ampicillin (5% each in vaseline and doritin) gave a +2 positive reaction and confirmed a suspected fixed drug reaction. TREATMENT AND COURSE: After amoxycillin had been discontinued and local class III steroids had been administered (mometasone furoate, Ecural) for one week the cutaneous changes disappeared without complication, except for slight hyperpigmentation. H. pylori eradication was continued without further complications using clarithromycin, metronidazole and pantoprazole. The patient was issued with an "allergic to penicillin" card. CONCLUSION: Intertriginous changes during antibiotic treatment may not be due to Candida intertrigo, which is fairly common, but to a prognostically much more important drug reaction.
A 79-year-old virgo intacta presented with a 20-year-history of intertrigo, and a 3-month history of superimposed warty masses beneath both breasts and in the groin and perianal areas. There was no evidence of immunosuppression. Histology of the warty lesions showed squamous papillomata, with evidence of wart virus infection. Human papillomavirus (HPV) type 6 was identified by in situ DNA hybridization, in the submammary lesions. This is an unusual manifestation of both intertrigo and wart virus infection. HPV-6 is classically found in anogenital warts. We assume that these warts were acquired by a non-venereal route and/or by congenital infection some 78 years ago. We suggest that it is the warm, moist environment, rather than the specific site, which encourages HPV-6 to flourish.
A scanning electron microscopic (SEM) study of intertrigo is presented. Marked changes of the keratinocyte surface characteristics and in the number and distribution of bacteria in the various stages of intertrigo are reported. Bacterial overgrowth was significant. This study confirms the value of SEM in the study of the skin surface and in cutaneous microbiology.
Intertrigo is an inflammatory dermatosis involving the body folds. Predisposing factors include constant friction opposing skin surfaces, obesity, sweating and occlusion. Colonization with bacteria, yeast and dermatophytes may exacerbate the dermatosis. Irritant antiseptics may aggravate intertrigo and provoke an allergic contact dermatitis. Treatment consists in careful drying the skin. Antimicrobial agents topically applied may be helpful. Predisposing factors should be corrected carefully.
Severe skeletal retrognathia may lead to a pronounced labiomental fold. When severe the labiomental fold may result in intertrigo, which is chronic and symptomatic. This problem can be managed by orthodontics and orthodontic surgery to reposition the jaw at a more anterior direction, thus creating a normal lip posture and a normal labiomental fold.
We report a case of bilateral intertrigo of the third and fourth interdigital spaces of the feet in a 34-year-old immunocompetent Senegalese male. A diagnosis of Fusarium solani infection was made. Systemic and topical therapy with terbinafine led to clinical but not mycological recovery. As this mould is potentially dangerous for immunodepressed subjects, early diagnosis and rigorous follow-up of skin diseases caused by this agent are advisable.
We describe a 49-year-old male patient who presented with an acute illness associated with a widespread maculopapular eruption and eroded lesions in the inguinal folds consistent with an acute intertrigo, for which search of mycological and bacteriological causes remained negative. Serological tests disclosed a high viral HIV-1 load and p24 antigenemia, while anti-HIV-1 antibodies were absent, a profile typical of acute HIV-1 infection. Since the maculopapular eruption regressed concomitantly with the orogenital lesions as well as the eroded inguinal lesions prior to specific therapy, our observation indicates that intertriginous lesions may constitute one of the early cutaneous markers of primary HIV-1 infection.
Group A beta-hemolytic streptococci have been implicated in a variety of common childhood cutaneous infections. Infants and young children may be particularly susceptible to a form of streptococcal intertrigo that has heretofore been underrecognized in this population. Manifesting as intense, fiery-red erythema and maceration in the intertriginous folds of the neck, axillae, or inguinal spaces, the condition is characterized by a distinctive foul odor and an absence of satellite lesions. Specific clinical features help differentiate this condition from its clinical mimics. Topical and oral antibiotic therapy with or without concomitant low-potency topical steroid application is generally curative.
A double-blind comparative study between 1% hydrocortisone cream and a combination of 1% hydrocortisone cream and 2% miconazole cream has highlighted some of the problems with this type of research in general practice. The collection of adequate patient numbers within a predefined time scale proved a major problem. However, the study demonstrated the safety and efficacy of both these preparations in the treatment of intertrigo.
OBJECTIVE: To determine the proportional contributions of tinea pedis, intertrigo, erythrasma and Candida to 'swimmer's eczema.' DESIGN: Descriptive. SETTING: Department of Dermatology, University Hospital Leiden, the Netherlands. METHOD: General practitioners were encouraged to refer every patient with clinical signs of foot mycosis. Mycological tests (culture and microscopy) were performed. RESULTS: A total of 296 patients with interdigital mycosis and 30 with tinea pedis of the moccasin type were included. In 56% of the patients with swimmer's eczema dermatophytes were recognised, 10% showed erythrasma and in 30% no cause could be found. Candida only played a minor role. Trichophyton mentagrophytes was found more often in swimmer's eczema than in tinea pedis of the moccasin type. CONCLUSION: Swimmer's eczema has several causes, which can be determined with mycological tests. Microscopy is the most sensitive method in regard to demonstrating dermatophytes and erythrasma.
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