Candida Intertrigo: Types, Symptoms, Risk Factors, Diagnosis, and Treatment

Introduction:

Intertrigo is a common skin condition caused by rubbing opposing skin surfaces under the influence of environmental factors and organisms like candida. It usually looks like a reddish rash and can get intensified by heat and moisture. The moisture increases friction, which can cause skin damage and inflammation.

In most cases of intertrigo, the injury to the skin leads to the overgrowth of fungus or bacteria. The overgrowth of bacteria leads to inflammation and rash, which can further cause secondary infection in the body.

What Is Candida?

Candid is a type of yeast or fungi freely present in the human body and is the common cause of fungal infections. Candida is usually found on most mucosal surfaces, the gastrointestinal tract, and the skin. Candida albicans is one of the most common species and opportunistic pathogens that can cause infections in humans and animals.

Candidiasis is an infection caused by Candida albicans. This is one of the most common types of fungal infection. It can affect any skin surface of the body, but most of it appears in warm and moist areas like the armpit and groin. It is also common in patients who are obese and have disorders like diabetes. It can also affect areas like nails, corners of the mouth, and intimate areas.

What Is Intertrigo?

Intertrigo is an inflammatory rash that occurs when two skin surfaces or skin folds come in contact, and the rash appears with friction, moisture, and lack of airflow. The most commonly affected areas are beneath the breasts or pannus (abdominal skin folds), the place under the arms (axillae), the scrotum (testes), buttock folds, between fingers of hands or feet, and corners of the mouth. The main factor responsible for the development of the lesion is the friction between the skin.

Additionally, this condition is common in both genders and all races. However, it is more common in diabetic, obese individuals living in hot and humid climates and bedridden older people.

What Are the Different Types of Intertrigo?

Intertrigo can be of different types depending upon the area and if it caused an infection or not. Some of the known types of intertrigo are -

1. Acute Intertrigo - If the patient is recently affected by this condition, it is called acute intertrigo.

2. Recurrent Intertrigo - If a patient has multiple recurrent cases of intertrigo, it is called recurrent intertrigo.

3. Chronic Intertrigo - When the patient has had the infection for more than six weeks, it is termed chronic intertrigo.

4. Uncomplicated Intertrigo - When there is no other infection related to intertrigo, it is known as uncomplicated intertrigo.

5. Interdigital Intertrigo - When intertrigo occurs between fingers and toes, it is termed interdigital intertrigo.

6. Candidal Intertrigo - When intertrigo is affected by the yeast or fungus known as candida, it is called candidal intertrigo. This is one of the most common causes of intertrigo.

7. Diaper Rash - It is a form of intertrigo, also known as diaper dermatitis.

What Are the Most Common Areas Affected by Intertrigo?

Intertrigo can occur in any skin areas that are in close contact with each other. Some of the most commonly affected areas include -

• In the armpits.

• Beneath or between breasts.

• Between belly folds.

• Between the buttocks.

• Between the creases of the neck in obese people.

• In the groin, on the scrotum (testes skin surface).

• At inner thighs.

• Between toes and fingers.

The areas mentioned above are most commonly seen in fully grown adults. Still, babies can also get affected by intertrigo as their skin is more delicate, and they have moist skin from wearing diapers or drooling. The most commonly affected areas for babies include -

• On the buttocks or groin area because of diapers (diaper rash).

• Between the folds on their arms and legs or neck.

What Are the Symptoms of Candida Intertrigo?

The symptoms of candida intertrigo are almost the same; the only difference is that these symptoms get exaggerated with a candida infection.

Early symptoms of intertrigo without any infection include -

• Red or reddish-brown rash with small bumps.

• Feeling itch, sting, or burning sensation in the affected area.

• Having pain.

If the symptoms mentioned above are not treated, they can develop into the following symptoms -

• The skin turns raw, and cracks appear on the skin.

• Bleeding or oozing from the affected area.

With superadded infections such as candida, the following symptoms appear such as -

• Foul smell from the affected area.

• Raised and painful bumps on the affected area.

• Extreme itching, pain, or burning sensation in the area.

In case of all these symptoms, patients should immediately consult a doctor and take prompt treatment as it can cause further secondary infections if left untreated.

What Are the Risk Factors of Intertrigo?

The most common risk factors ideal for the growth of candida are warm and moist environments. Factors that affect or promote the development of candida in these areas include-

1. Factors Responsible for Skin Friction -

• Activities leading to skin-on-skin rubbing, like running.

• Obesity.

• Tight-fitting clothes.

2. Factors That Increase Moisture -

• Obesity.

• Hyperhidrosis (excessive sweating).

• Wearing clothes such as rubber gloves promotes more sweating.

3. Conditions or Factors That Affect the Immune System -

• Diabetes mellitus.

• Use of steroids such as Prednisone or Hydrocortisone.

• Overuse of antibiotics for an extended period.

• HIV infection.

• Chemotherapy.

• Medications decrease the immune response (such as in treating rheumatoid arthritis) and transplant patients.

How Is Intertrigo Diagnosed?

Intertrigo is a common condition, but it is sometimes difficult to diagnose as it resembles various other skin conditions. It can be diagnosed based on the appearance of a rash and the risk factors. If the healthcare provider suspects any yeast or bacterial infection, additional tests may also be done, such as -

• KOH (Potassium Hydroxide) Test - This test helps detect yeast or bacterial growth by scrapping the dead skin cells from the affected areas. These are then mixed with potassium hydroxide solution and examined under a microscope.

• Bacterial Cultures - This test helps diagnose any secondary bacterial infections.

What Is the Treatment of Intertrigo?

The uncomplicated and uninfected intertrigo can be easily treated with topical ointments. In addition, applying a drying solution such as Burow's solution to the skin folds several times a day for 20 to 30 minutes can help treat the rash.

In case of infected intertrigo or candida intertrigo, topical antifungals can be used, which include-

• Econazole.

• Ketoconazole.

• Clotrimazole

• Nystatin.

• Oxiconazole.

• Miconazole.

For bacterial infections, some antibiotics can be used, such as

• Mupirocin.

• Erythromycin.

In some cases, topical steroids such as Hydrocortisone can also be prescribed, which helps suppress the symptoms.

Conclusion:

Intertrigo is a common skin condition that can be uncomfortable and stubborn sometimes. Patients usually ignore these conditions, but these can worsen and lead to secondary infections without proper treatment. Therefore, it is always in the interest of a patient to contact a medical professional if experiencing any symptoms to get effective treatment to stop the problem.