Intertrigo: A Red Rash In The Skin Folds

Cynthia Bailey, MD|September 1, 2010

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?

  1. Moisture from sweat
  2. Rubbing together of folded skin, causing the dead skin cells to rub off and accumulate
  3. Irritation caused by normal skin germs which thrive in this environment
  4. 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. Preventative care

  • 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.)

Important precautions:

  • 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. If you found this information helpful, you may also want to read: Stop The Summer Darkening Of Your Age Spots Cracked, Dry and Splitting Fingernails; Dermatologist's Tips Dermatologist's 3 Simple Steps To Have Sandal Ready Feet By Spring Photo: Gratitude and thanks to Ashley Webb 

Photo Modified 7/21/16 Copyright © Dr. Bailey Skin Care LLC 

I have been having the red rash accompanied by bleeding sores which I got under control but still tender and painful.

By Roger on 2016 10 17

Hello Roger,
I hope the info I’ve given helps provide some relief. Warm Regards, CBMD

By Cynthia Bailey, MD on 2016 10 25

Thank you so much! You have no idea how you have brightened my outlook on well, everything! I have been looking for months for help on what to do with what I am dealing with between my skin along with 10,000 other things. I am not used to being heavy and I just want to know how to adjust. Do you have a blog or anything? If so, please let me know; Again, thank you

By Jen Woldt on 2016 10 27

Hello Jen,
Life is full of changes that’s for sure. Here is another post I wrote on intertrigo https://www.drbaileyskincare.com/info/blog/intertrigo-prevention-and-skin-care-tips

By Cynthia Bailey, MD on 2016 10 30

Thanks for these tips!!!

By Shelly Marie on 2016 11 20

I’ve been trying all kinds of treatments for this rash on my belly (I’ve got that abdominal-skin-fold thing going on since gaining wt.)  I’m so glad to come across your site and will do all that you have recommended to try to get this cleared up without having to go to the Dr.  Thanks for your help!

By Bev Gartner on 2016 11 29

Found this very helpful.  I have had this problem just occasionally over the years, but more frequently lately.  I’ve tried out a few things when I’ve had a flare-up and I’ve found that it responds to Polysporin, which implies it’s bacterial rather than fungal, I think?  Not sure if it’s worth trying anti-fungal cream in that case?

By Carol Cooper on 2016 12 09

Hello Carol,
Many of my patients try Polysporin or Neosporin for intertrigo before seeing me. The problem is that one can become allergic to the active antimicrobials. In my experience, patients do much better with the care I described above. Best wishes! CBMD

By Cynthia Bailey, MD on 2016 12 15

I was wondering if the antibiotic zythromax,which I was just on for bronchitis, could have initiated this condition. My belly fat has had a roll for a couple years but this is the first time I ever developed any kind of rash. I was also wondering if you might have an idea why my belly button is so stinky. It’s always been very stinky. It smells almost like a dead animal. I clean with Q-tips but doesn’t seem to make a difference. I also shower almost every day so l dont know why I can’t clear this issue up.  Thank you for your time and expertise.

By Amy on 2016 12 17

Hello Amy,
I am sorry about your troublesome rash and all it’s unpleasant frustrations. The skin is amazing frankly. It has many microbes living on it and usually they are living in harmony - but not always. I can’t say if the zithromax and your rash is a cause and effect for your skin rash because I can’t give specific evaluation, advice or even opinions with my web work for any specific person. I can say that antibiotics that treat bacteria will skew the skin microbial balance towards the yeast. Yeast love folds, especially if there is any tendency for diabetes. Healthy skin folds should not smell when clean. Infections and intertrigo can have an offensive odor. The care I outline above is how I address the treatment of intertrigo in my practice. I hope the info helps. Remember, troubling skin problem that don’t respond to general care are best evaluated by a trained dermatologist in person.

By Cynthia Bailey, MD on 2016 12 19

Wow. Thank you for the information about the cornstarch baby powder. I had no idea it could be making it worse! That explains why it’s really not getting better very quickly.

By Tamra Phelps on 2017 01 16

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