Everybody has areas where their skin folds over on itself. When skin is warm and sweaty the conditions are perfect for intertrigo, the common skin fold rash. The skin folds most affected by this rash are those under the breasts, under the stomach, and in the arm pits. The deeper the folds, the more likely the chance for intertrigo.
What makes the skin folds susceptible to this annoying red skin fold rash?
- Moisture from sweat
- Rubbing together of folded skin, causing the dead skin cells to rub off and accumulate
- Irritation caused by normal skin germs which thrive in this environment
- Growth of a yeast germ called candida, which occasionally also ‘dog piles’ on the problem making a real mess of the skin
Who gets intertrigo?
Anyone with sweaty skin. In my practice I mostly see adults with intertrigo. People with large breasts or a fold under their belly fat are especially prone to intertrigo. Babies can also develop intertrigo in their little skin folds. Because the skin germs thrive in a sweet and sugary environment, diabetics are particularly prone to intertrigo; they often also get the candidal yeast infection in the folds making their rash particularly severe.
The common risk factor is prolonged moist and warm skin from sweating. I see patients with this skin fold rash all year long. During the summer it’s due to the hot weather. In the winter it’s because of the layers of thick clothing worn to keep warm.
Dermatologist’s Recommendations for Care and Prevention for Intertrigo Prone Skin
These are the recommendations that I give my patients. I’ve found that the trick to treating and preventing intertrigo is to try to keep the skin folds dry and sweat free. Using anti-yeast skin care products also helps. For really irritated skin I add a short course of nonprescription cortisone cream.
- Wash your skin folds with Dial soap. The anti-bacterial ingredient in Dial will decrease the skin germs. Dial also has an ingredient that acts like an antiperspirant and will block your sweat ducts, decreasing sweat in your folds. I don’t recommend using Dial soap elsewhere on your body because it’s simply too drying, and frankly, you don’t need antibacterial ingredients and clogged sweat ducts on the rest of your skin.
- After bathing, towel-dry your skin and then blow dry your folds until they are totally dry.
- Apply Zeasorb AF powder to your dry skin folds. Zeasorb AF contains an anti-yeast medicine. Never ever apply corn starch based-powders to your skin folds because the starch feeds yeast.
- Wear breezy, loose cotton or linen clothing that breathes and allows sweat to air dry quickly. You can even separate your folds with absorbent cotton cloth. Avoid synthetic and thick fabrics that don’t allow your sweat to air dry.
- Stay cool to decrease sweating.
Treatment of Intertrigo
If the red, painful and sometimes even smelly rash of intertrigo flairs up in the skin folds in spite of following the skin care outlined above, then medicine is needed to control it. Luckily there are effective medicines over the counter. In addition to my care instructions above, I have my patients stop applying the Zeasorb AF powder after blow drying their folds and instead apply the following medicine to the affected area twice a day:
- Clotrimazole cream (eg. Lotrimin Cream). Clotrimazole Cream needs to be used for at least 2 weeks because it takes 2 weeks to fully treat a yeast infection.
- If clotrimazole cream alone does not start to decrease the redness within a few days, I then have patients add a thin layer of 1% hydrocortisone cream after the clotrimazole cream. I tell them to stop the hydrocortisone a soon as possible because it can thin the skin. (If you chose to use hydrocortisone, don’t use it or more than 2 weeks without seeing your doctor and having them supervise your treatment.)
- All cream products have ingredients that can sting damaged skin, including the rash of intertrigo. Of course, severe stinging is a sign you need to see your doctor and have your diagnosis confirmed and treatment supervised by them.
- Don’t use clotrimazole or hydrocortisone creams with other active ingredients like anti-itch medicines (Benadryl, ‘cains’ etc) because you can become allergic to them, and this will make the rash even worse.
- Severe intertrigo can be weepy and very tender. You will need to see your doctor if your rash has gotten really bad.
- Not every skin fold rash is intertrigo, anyone whose rash is not responding within a week needs to see their doctor to confirm their diagnosis.
- Babies’ skin is so delicate that treatment should always start with a doctor’s exam and should be supervised by their doctor as well.
- Diabetics are much more prone to intertrigo than everyone else and so anyone who is continuously troubled by this annoying red skin fold rash needs to be seen by their doctor and tested for diabetes.
Lastly, I recommend that even non-diabetics who are prone to intertrigo consider avoiding foods that raise their blood sugar. This includes high glycemic foods like sweets, refined flour foods and sugary drinks. ‘We are what we eat’ and a low glycemic, veggie-intense healthy diet is ideal for supporting skin health.
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Photo: Gratitude and thanks to Conorwithonen