Did you ever wonder what effects summer weather has on the skin? Intertrigo, a common skin concern, is notorious for flaring in response to hot humid weather. Intertrigo affects so many people but most have no idea of why they experience this annual mystery. Intertrigo affects the health of the areas hidden by heavy skin folds. Heat and humidity along with darkness combine to create the proper conditions intertrigo. Because the environmental factors play such am important role, intertrigo tends to flare each summer. Intertrigo is basically a yeast infection of the skin found under skin folds. The delicate skin under the breasts is most prone to developing intertrigo. Other areas that can become affected include the area under abdominal folds and sometimes folds on the thighs or pubic areas.

Intertrigo is due to the overgrowth of yeast called candida albicans. These yeast do not normally live on the skin so this is considered an infectious process.

Moisture builds under the skin fold and the yeast flourish leading to symptoms such as redness, scaling and significant itching. The skin may develop some raw spots. Little red bumps and pustules may be present. Typically the involved skin is a sheet of redness.

FLARE FACTORS

Diabetics or anyone with borderline elevated blood sugars may find themselves more prone to developing intertrigo, although you can be perfectly healthy and still have this problem arise. It's more an issue of the presence of the perfect environmental factors that help create this situation than the presence of nourishing high blood sugar.

Breastfeeding is certainly a wonderful natural way to nourish your infant. But all those hours of holding that cuddly warm body against your chest may take its toll, especially if you have larger breasts. If you find you are experiencing intertrigo due to this, your lactation expert or physician should be able to find a solution appropriate for your situation. Keeping the area as cool and dry as possible is the key here. And of course, the baby should not be consuming any of your topical skin care treatments.

TREATMENT

Treatment is aimed at eradicating the infection AND focusing on the environmental issues that are present. If this is not done, it is likely that intertrigo will be a chronic concern. Your approach to intertrigo is summarized in 3 key points:

• Dry It
• Treat It
• Prevent It

The last thing you want to do is apply tons of goopy wet creams or ointments to the area; this is just going to make the area ripe for further flare-ups. I like using a prescription medicated powder called Mycostatin Powder and have my patients apply it 3-4 times a day if possible. The powder helps keep the area dry as well as kills the yeast. Mycostatin powder can be used on a maintenance basis to help prevent intertrigo when regular powders don't work.

If another yeast killing product is required, prescription Nizoral Cream is ideal. Keep 2 things in mind. I sometimes find that this product can be irritating, particularly for anyone with a very inflamed case. Also, whatever cream you are going to apply should be used sparingly and rubbed into the skin leaving no surface trace of it. The last thing you need is more moisture here!

For resistant cases, the use of an oral anti-yeast medication such as Diflucan can be used. However, this does nothing to help treat the area. Either Mycostatin Powder or Zeasorb-AF Antifungal Powder should be used frequently to help keep moisture at bay and treat surface yeast, too. You can always apply extra powder, Zeasorb-AF Antifungal Powder, as desired.

Advanced cases with weeping or raw areas will need additional loving care here. Understandably the skin will likely be quite sensitive, perhaps painful. Make certain you are not wearing clothing that is helping rub the area raw. Avoid wearing bras if need be if you are to this point until the situation is under control. The use of astringent drying agents like Domeboro Astringent Solution can be applied with a moist washrag for 20 minutes twice a day. Treat raw spots with tiny dabs of antibiotic ointment like Polysporin First Aid Antibiotic Ointment. Another product, colorless Castellani's Paint, is great for exuberant amounts of oozing. It is simply painted onto the area and helps to dry and kill some of the bacteria that tend to take advantage of broken skin.

Wait a few days until the oozing is under control before trying to apply creams. You can try the application of your medicated powder, but again, you may have to wait until the moisture has been reduced.

COOL AS A CUCUMBER

A simple way to help heal intertrigo, regardless of severity is to allow air to reach the affected region. Twice a day, lift up the skin fold (abdominal fold, breast, etc.), and allow air to circulate. This should be for a good 10 minutes if possible. Remember, this seems like a long time when you are standing around, so make sure you check the clock.

After washing I have had patients who find that using their hair dryer on the cool setting and drying the affected zones in this manner helps control their flare-ups.

TRIAL AND ERROR

It's not unusual for me to see patients who have tried everything for their "intertrigo" only to find out on their evaluation that they didn't have it at all! Most non-dermatologists and a few specialists may overlook the true source of your suffering. There are two main reasons for a misdiagnosis.

The most likely reason to experience a case of unresponsive intertrigo is having a case of psoriasis instead! Every patient I evaluate with intertrigo gets a simple painless diagnostic skin scraping called a KOH to verify they really have intertrigo. If I cannot find any evidence of infection, I look for the true cause of their condition.

KOH 101

While I realize that there are false negative KOH readings, (perhaps someone applied an anti-yeast/fungal product within a few days of their exam or just showered, temporarily washing away much of the superficial infection), most of the time it's reliable. If I still suspect the presence of the infection despite a clear KOH I will perform a fungal culture that can take up to 3 weeks to be able to help diagnose the problem. However, most KOH results are straightforward and I always think through the other options if the KOH is normal.

Psoriasis that mimics intertrigo goes by a variety of names. Inverse psoriasis, napkin psoriasis, they are the same. Determining the true diagnosis may involve looking elsewhere. Does the patient have other signs of psoriasis? Is there a past history that makes sense? I'll evaluate their nails, scalp, elbows, and knees, anything that can help detect another possible diagnosis.

Psoriasis in these areas is often tricky to treat as the skin is far more sensitive and the doctor cannot resort to high potency topical steroids. The heavy skin folds will push the steroid further into the skin and can result in thinning of this already thinner skin (atrophy). Signs of this may be stretch marks, easy tearing of the skin and visible tiny blood vessels or bruising.

Psoriasis is often flared by the presence of yeast or bacteria. Since you can assume that there are probably some of these in a hot moist environment, I will add some form of anti-yeast therapy to my treatment of the psoriasis along with a low potency topical steroid lotion (lighter than a cream or ointment). Delicate tissues under the breasts and nether regions often will not tolerate the newer psoriasis treatment, Tazorac. Instead, ask your dermatologist about Dovonex, a vitamin D derivative less likely to be an irritant under your breasts.

A latex allergy may less commonly make its initial presentation by disguising itself as intertrigo. Latex is a component of elastic. Just imagine those elastic leg bands rubbing within a skin fold. It is a tough diagnosis to call, but awareness does help in its recognition. Patch testing and a simple blood test can easily clinch the diagnosis for most patients. Avoidance is the final treatment, although the use of topical steroid creams and the use of antihistamines will help clear the allergic reaction.

Relief from intertrigo often accompanies the change of seasons as long as you treat the condition effectively. If you are prone to this condition, add preventative maintenance therapy into your skin care routine. Applying an absorbent powder is easy to do after washing. Make certain you avoid the use of cornstarch based body powders. Cornstarch acts as a veritable feast for candida. A talc-based powder is your best solution, preferably one that is medicated.

Keep calm cool and collected this summer. You probably know more than many primary care doctors about what's ailing you!

Thank you for taking the time to read through this important information. I hope you have found this article informative.

Audrey Kunin, M.D.

(Any topic discussed in this article is not intended as medical advice. If you have a medical concern, please check with your doctor.)

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