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Intertrigo is the clinical description of a cutaneous inflammatory process on opposing skin surfaces.
Preventing and treating intertrigo in the large skin folds of adults: a literature overview. Gram-negative bacterial toe web infection: a survey of 123 cases from the district of Cagliari, Italy. Acute genitocrural intertrigo: a sign of primary human immunodeficiency virus type 1 infection. A comparison of a new antifungal agent, 1 percent econazole nitrate (Spectazole) cream versus 1 percent clotrimazole cream in the treatment of intertriginous candidosis. Not sure what to do now that the USPSTF and other organizations have questioned the utility of routine pelvic exams? Many women die each year from preventable cervical cancer, yet doctors aren't urging their younger patients to get vaccinated--possibly to avoid awkward discussions about STDs, an ethicist says. All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. A new education programme can cut the chances of developing type 2 diabetes by 80 per cent, according to a study. Full attendance on the programme, which includes a main session and two follow ups over a two-year period, results in an 88 per cent risk reduction, while people who only missed one follow up session were 60 per cent less likely to develop type 2 diabetes.
An adapted version of the Let’s Prevent Diabetes programme is now being rolled out in the East Midlands and parts of Yorkshire as part of NHS England’s The Healthier You: NHS Diabetes Prevention Programme. The findings were made from an analysis on research which was supported by the National Institute for Health Research (NIHR), which examined 880 people from 44 GP surgeries.
They either received standard care or the six-hour group structured education programme focused on physical activity and empowering people to make healthier lifestyle choices.
The programme includes an annual refresher course, and regular phone contact to increase motivation every three months. Both groups received standard written information and participants were followed up for three years. People who attended the main session and one other reduced their risk of the condition by 60 per cent and these who attended all of the programme were almost 90 per cent less likely to develop type 2 diabetes. As well as potentially reducing the risk, the group receiving the education programme also saw significant improvements in HbA1c, cholesterol, well-being, sedentary time and step counts.
The study was supported by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East Midlands, which turns research into cost-saving and high-quality care through cutting-edge innovation and the NIHR Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, which harnesses the power of experimental science to explore and develop ways to help prevent and treat chronic disease. The Leicester Diabetes Centre is an international centre of excellence in diabetes research, education and innovation, led by Professor Davies CBE and Professor Kamlesh Khunti. Hosted at Leicester General Hospital, the centre is a partnership between the University Hospitals of Leicester NHS Trust and the University of Leicester.


A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. The friction in these folds can lead to a variety of complications such as secondary bacterial or fungal infections. The usual approach to managing intertrigo is to minimize moisture and friction with absorptive powders such as cornstarch or with barrier creams.
The condition is particularly common in obese patients with diabetes who are exposed to high heat and humidity, but it can occur in anyone. Patients should wear light, nonconstricting, and absorbent clothing and avoid wool and synthetic fibers.
Other predisposing risk factors include urinary and fecal incontinence, hyperhidrosis, poor hygiene, and malnutrition.
Physicians should educate patients about precautions with regard to heat, humidity, and outside activities. Toe interweb intertrigo may be associated with closed-toe or tight-fitting shoes and commonly affects persons participating in athletic, occupational, or recreational activities.
Physical exercise usually is desirable, but patients should shower afterward and dry intertriginous areas thoroughly.
Infants are at high risk for intertrigo because they have short necks, relative chubbiness, and flexed posture.3,4 Drooling also can facilitate intertrigo in infants.
Persons with prominent skinfolds on either side of the chin are at a high risk for intertrigo.5Secondary Skin InfectionsThe moist, damaged skin associated with intertrigo is a fertile breeding ground for various microorganisms, and secondary cutaneous infections commonly are observed in these areas. Secondary bacterial and fungal infections should be treated with antiseptics, antibiotics, or antifungals, depending on the pathogens. Gram-positive and gram-negative bacteria also can worsen the effects of interdigital intertrigo.
Yeasts also are commonly found at the site of interdigital intertrigo.9 Sometimes seborrheic dermatitis is located in the folds. Patients may present with itching, burning, and pain in the affected areas.1,3 More prominent inflammation could be a sign of secondary infection. In severe examples, patients may have a purulent discharge with edema and intense erythema of tissues surrounding the infected area. Patients with severe toe web intertrigo who are overweight or who have diabetes are at a higher risk for cellulitis. Patients with advanced gram-negative infections may have green discoloration at the infection site.
Acute genitocrural intertrigo in patients with human immunodeficiency virus type 1 (HIV-1) infection may present as a maculopapular eruption.12DiagnosisDiagnosis of intertrigo and its secondary complications often is clear and is generally based on clinical manifestations.


If secondary bacterial infections are suspected, culture with sensitivities should be performed. A Wood’s light examination may identify a Pseudomonas or erythrasma infection more quickly than would a culture. The Wood’s light characteristically shows a green fluorescence with Pseudomonas infection and a coral-red fluorescence with erythrasma. Potassium hydroxide cytologic examination is helpful in diagnosing secondary fungal infections.
Seborrheic dermatitis and psoriasis vulgaris inversa may have presentations similar to intertrigo.13,14 Seborrheic dermatitis may involve the axillae or inguinal regions or the scalp. Psoriasiform lesions elsewhere on the body or pitting of the nails also may distinguish psoriasis from intertrigo.
Rarely, skin biopsy specimens are needed to distinguish less common skin diseases from intertrigo.
Atopic dermatitis, primary irritant contact dermatitis, allergic contact dermatitis, scabies, and pemphigus vegetans sometimes are mistakenly diagnosed as intertrigo because these conditions also may involve skinfolds.
Some suggest the use of absorptive powders, such as talc and cornstarch, or barrier creams. These topical treatments, however, have little or no proven benefit and may cause irritation or facilitate yeast colonization.2 Obese patients should lose weight, if possible. Cutaneous erythrasma is best managed with oral erythromycin (250 mg four times daily for two weeks).
If the patient does not improve after treatment, bacterial culture and sensitivity should be performed.Toe web infections can be serious,7,8 and severe cases may warrant hospitalization.
Proper identification of gram-negative organisms is critical so that effective antibiotic therapy can be initiated. Tissue removal may be needed to allow absorption of topical antibiotic agents, which promote healing and slow the spread of infection.
Third-generation cepha-losporins and quinolones are active, together with aminoglycosides.7,8 Oral antibiotics combined with cleansing and debridement, 5 percent amikacin gel, and hot compresses of 2 to 5 percent acetic acid for 15 days may be effective. Physical exercise usually is desirable, but patients should shower after exercise and keep intertriginous areas thoroughly dry.



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