Abstract
Candidial intertrigo is a superficial fungal infection that affects intertriginous areas—regions where skin folds rub together and retain moisture. It is commonly caused by Candida albicans and presents as erythematous, macerated plaques with satellite pustules. The condition is particularly common in obese individuals, diabetics, and immunocompromised patients. This article explores the pathogenesis, clinical features, differential diagnosis, diagnostic approach, and management of candidial intertrigo.
Introduction
Intertrigo refers to inflammation of skin folds due to friction, moisture, and lack of air circulation. When secondary colonization or infection by Candida species occurs, it is termed candidial intertrigo. This condition is frequently encountered in clinical practice, especially in hot and humid climates.
Etiology and Risk Factors
The primary pathogen involved is Candida albicans, although other Candida species may occasionally be responsible.
Risk Factors:
- Obesity
- Diabetes mellitus
- Immunosuppression (e.g., HIV, chemotherapy)
- Prolonged occlusion or excessive sweating
- Poor hygiene
- Use of broad-spectrum antibiotics or corticosteroids
- Infancy or elderly age
Pathophysiology
Moisture and friction in intertriginous areas (e.g., axillae, inframammary folds, groin, gluteal cleft) compromise the skin barrier. This environment favors colonization by Candida, a part of the normal skin flora, leading to overgrowth and infection. The yeast’s ability to form pseudohyphae and secrete enzymes contributes to skin invasion and inflammation.
Clinical Features
- Erythematous, shiny, moist plaques with well-defined borders
- Maceration and fissuring of skin in fold areas
- Satellite lesions: small papules or pustules at the periphery
- Burning, itching, or pain
- Common sites: inframammary folds, axillae, groin, intergluteal cleft, abdominal folds, interdigital spaces
Differential Diagnosis
- Tinea cruris (dermatophyte infection)
- Inverse psoriasis
- Erythrasma (caused by Corynebacterium minutissimum)
- Bacterial intertrigo (e.g., Staphylococcus aureus)
- Seborrheic dermatitis
- Contact dermatitis
Diagnosis
Primarily clinical, but confirmatory tests may include:
- KOH preparation: reveals pseudohyphae and budding yeast cells
- Fungal culture: useful in recurrent or treatment-resistant cases
- Wood’s lamp: no fluorescence in candidiasis (unlike erythrasma which fluoresces coral red)
- Skin biopsy: rarely needed, shows yeast in the stratum corneum
Management
General Measures:
- Keep affected area clean and dry
- Minimize friction and occlusion
- Encourage weight reduction if obese
- Use of loose, breathable clothing
Topical Antifungals (first-line):
- Clotrimazole, miconazole, ketoconazole
- Apply twice daily for 2–4 weeks
Topical Combination Therapy:
- Mild topical corticosteroids (e.g., hydrocortisone 1%) may be added short-term to reduce inflammation
- Avoid prolonged use to prevent skin atrophy
Systemic Antifungals:
- Fluconazole or itraconazole for extensive or resistant cases
- Dose: Fluconazole 150 mg weekly or 50–100 mg/day for 1–2 weeks
Adjunctive Therapies:
- Barrier creams (zinc oxide)
- Antiseptic powders to reduce moisture
Prognosis and Complications
- Excellent prognosis with appropriate treatment
- Recurrences are common if predisposing factors are not addressed
- Secondary bacterial infection may occur if untreated
Prevention
- Control underlying conditions (e.g., diabetes)
- Improve hygiene and skin care practices
- Use of drying powders or antifungal prophylaxis in high-risk individuals
- Regular monitoring in immunocompromised patients
Conclusion
Candidial intertrigo is a common yet preventable and treatable skin infection. A high index of suspicion is required in predisposed individuals, and management involves both antifungal therapy and addressing underlying risk factors. With timely intervention, the prognosis is generally excellent.