Clive Anderson - AT THE DERMATOLOGIST

A RASH occurring in the body folds is known as intertrigo. The areas usually affected are the inner thighs, armpits and the underside of the breasts or belly. Intertrigo frequently occurs in overweight or obese persons where any overlapping skin fold may be affected ­ the abdomen, neck, creases or under the breasts. It is an inflammatory condition of the skin which is caused by high skin temperature, moisture from sweating and friction from the movement of adjacent skin resulting in chafing.

Bacteria and yeasts, which are normally resident on the skin, multiply happily in such conditions and result in further damage to the skin. This inflammation of the skin then is caused by a combination of mechanical factors (heat, moisture and friction) and secondary infection. The infectious agent is frequently the yeast Candida, but it may be bacteria or even a virus.

Intertrigo is very common in hot humid climates and is a complication of diabetes. Diaper dermatitis shows several features of intertrigo. The condition is usually a chronic one with frequent relapses occurring in warmer seasons. In addition to heat and humidity, strenuous activity in which chafing occurs may be a trigger. Sweat, faeces, urine and vaginal discharge may aggravate intertrigo in both adults and infants.

The symptoms associated with intertrigo usually come on slowly with burning, itching and stinging in the skin folds. The skin is red and may ooze. Fissures may develop in the folds and the appearance of pus ­ bumps or water ­ bumps may herald infection.

A visit to the dermatologist will rule out other skin diseases such as a contact dermatitis, seborrhoeic eczema, psoriasis and other less common conditions. Some investigations may be necessary to determine the cause of the intertrigo. These may include a skin scraping to examine under the microscope for fungi, an examination with a particular light (woods light) to diagnose a bacterial infection and a skin biopsy to rule out other causes.

Medical care revolves around removing the causative factors with certain general measures and treatment for the underlying cause.

Reduce heat by wearing loose clothing and underwear.

Wash the area with a mild soap or non-soap cleanser.

Reduce moisture by drying well after bathing ­ use a fan or a blow dryer

Wear absorbent cotton underwear

Use an absorbent powder once the area is less macerated

Separate skin folds with cotton

Frequent compresses with very dilute vinegar or wet tea bags are helpful.

Commercially available barrier pastes such as Desitin are helpful.

Reduce weight and control diabetes.

Your dermatologist will frequently recommend an anti-fungal cream or one that combines the anti-fungal with an anti-inflammatory product such as a mild steroid. In some cases an anti-bacterial agent may be required. With treatment the episodes of intertrigo are easily controlled but...recurrences are common.

Dr. Clive Anderson is a Dermatologist and Venereologist.