Intertrigo is a red rash of the skin folds

An intertrigo rash is sometimes called a ‘sweat rash’. It can appear when folds of moist skin continually rub together. Intertrigo (pronounced ‘inter-tri-go’) is fairly common and very uncomfortable. But with simple treatment and changes to how you care for your skin you can prevent and treat this condition.

What causes an intertrigo rash?

Everybody has areas where their skin folds over on itself. When this skin is warm and sweaty, the conditions are perfect for intertrigo. The aspects of skin folds that make them susceptible to intertrigo are:

• Moisture (especially from sweat).
• Friction of folded skin. This causes dead skin cells to rub off and accumulate.
• Irritation caused by normal skin germs that thrive in a moist environment.
• Growth of a yeast germ called Candida, which exacerbates the issue.

A sweat rash can occur all year round. In the summer it’s due to hot weather. In winter it’s caused by layering clothes to keep warm.

• In neck creases.
• Between the crack in the buttocks fold.
• On inner thighs.
• In the groin area.
• In the belly button.

The deeper the skin folds, the more likely the chance that intertrigo will develop.

Babies can also get intertrigo. If it appears on their buttocks and groin area, it’s often considered a form of ‘diaper rash’.

Intertrigo can flair up between the skin folds of a baby’s arms, legs and neck too.

Anyone with sweaty skin can get intertrigo, especially if you have excessively sweaty skin and/or hyperhidrosis. In my practice, I mostly see adults with this condition and the risk increases with age. But as mentioned above, babies can also get it.

People with large breasts or a fold under their belly fat are especially prone to sweat rash. It may show up as a red line under the abdomen apron.

Because skin germs thrive in a sweet and sugary environment, diabetics are particularly susceptible to intertrigo. They often also develop a Candida yeast infection which makes their intertrigo rash particularly severe.

Infections need immediate medical treatment to prevent further complications. Excessive body odor can also occur with stress sweat. This is different from an infection. That said, the excessive sweat from stress will place your skin at risk for intertrigo. When in doubt, it’s best to see your medical provider for an accurate diagnosis. 

What complications are caused by intertrigo?

Untreated intertrigo can lead to complications such as:

• Skin breakdown and ulceration. Ulcerated areas of skin are at risk for serious forms of infection.
• Cellulitis. This is a bacterial infection that can be life-threatening if it isn’t treated quickly. That’s because it can spread to other parts of the body.
• Sepsis. Intertrigo can lead to an infection that could cause sepsis, which is life-threatening.

When to seek medical help

You should see your doctor immediately if:

• You have symptoms of an infection (see above).
• An armpit rash, under belly rash or a sweat rash elsewhere on your body persists after a week of intertrigo care, or it gets worse. Not all skin fold rashes are intertrigo.
• You experience severe stinging from any cream use.
• You continuously suffer from an intertrigo rash. Ask your doctor to test you for diabetes. Diabetics have an ideal skin environment for intertrigo, making them more susceptible to the condition.

Treatments for infants should always be supervised by a doctor since their skin is so delicate.

Are there different types of intertrigo rash?

Your healthcare provider may use some of these terms when discussing intertrigo:

• Acute intertrigo. This means intertrigo has appeared recently and has been identified as needing treatment.
• Candidal intertrigo. When intertrigo has become infected by the fungus and yeast, Candida, it’s called candidal intertrigo and there may be little pustules along the active edge of redness.
• Chronic intertrigo. When intertrigo has lasted a long time (usually more than 3 months) it’s known as chronic intertrigo.
• Recurrent intertrigo. This is when intertrigo keeps coming back.
• Uncomplicated intertrigo. When a sweat rash is not infected it’s called uncomplicated intertrigo.

• Wash skin folds every day with antibacterial soap or body wash, such as Dial. This decreases skin germs and acts as an antiperspirant. Only apply the soap to the sweaty parts of your body otherwise it may be too drying.

• 

  Wash skin folds twice a week with a pyrithione zinc soap. This ingredient helps reduce a broad range of skin germs that can contribute to intertrigo. Get the full 2% strength in my Foaming Zinc Cleanser which is an effective body wash for intertrigo. It’s also a shampoo to treat dandruff and a skin cleanser to fight body acne.

• After bathing, towel-dry your skin and then blow dry skin folds until they are totally dry.
• Apply Zeasorb AF powder to dry skin folds. Zeasorb AF contains an anti-yeast medicine. Never apply corn starch-based powders to skin folds because the starch feeds yeast. Zeasorb AF is the best powder for skin folds!
• Wear breezy, loose cotton or linen clothing that breathes and allows sweat to air dry quickly.
• Separate skin folds with absorbent cotton cloth in sweaty conditions.
• Avoid synthetic and thick fabrics that don’t allow your sweat to air dry.
• Stay cool and say ‘yes’ to things that reduce stress and anxiety to decrease sweating.
• Shower as soon as possible after excessive sweating such as a sweaty workout. This will also help to prevent sweat acne, another skin problem from sweating. 

Intertrigo rash treatment

If a red, painful and sometimes smelly intertrigo rash continues to flare up, despite following the skin care recommendations above, then medicine is needed to control it. Luckily, there are effective treatments available over the counter.

I ask my patients to stop applying Zeasorb AF powder after blow drying skin folds. Instead, I advise them to apply clotrimazole cream (e.g., Lotrimin Cream) to the affected area twice a day. Clotrimazole needs to be used for at least two weeks because it takes two weeks to fully treat a yeast infection.

If clotrimazole cream doesn’t reduce redness within a few days, I ask patients to add a thin layer of 1% hydrocortisone cream after applying clotrimazole. However, I tell them to stop using hydrocortisone as soon as possible because it can thin the skin.

Never use hydrocortisone for more than two weeks without seeing your doctor. Avoid home remedies such as witch hazel because it can irritate this sensitive and red skin in the skin folds.

Can dietary changes help?

To prevent and treat an intertrigo rash, I advise both diabetic and non-diabetic patients to avoid foods with high glycemic (sugar) index: sweets, sugary drinks, and refined flours.

For information about a low sugar diet and easy recipes, please download my FREE eBook, Healthy Eating Guide: How to Eat Your Way to Beauty and Health – A Guide to an Alkaline Mediterranean Diet.

Click here to learn more about medicated pyrithione zinc containing cleanser Foaming Zinc.

Author: Dr. Cynthia Bailey M.D. is a Board Certified dermatologist practicing dermatology since 1987. She has done well over 200,000 skin exams during her career and authors the longest running physician written skin health blog in the world. 

References:

T Nobles, Intertrigo – StatPearls – NCBI Bookshelf, 2021, https://www.ncbi.nlm.nih.gov › books › NBK531489

Gabriel S, Hahnel E, Blume-Peytavi U, Kottner J. Prevalence and associated factors of intertrigo in aged nursing home residents: a multi-center cross-sectional prevalence study. BMC Geriatr. 2019 Apr 15;19(1):105. doi: 10.1186/s12877-019-1100-8. PMID: 30987588; PMCID: PMC6466768.

Kalra MG, Higgins KE, Kinney BS. Intertrigo and secondary skin infections. Am Fam Physician. 2014 Apr 1;89(7):569-73. PMID: 24695603.

Mistiaen P, van Halm-Walters M. Prevention and treatment of intertrigo in large skin folds of adults: a systematic review. BMC Nurs. 2010 Jul 13;9:12. doi: 10.1186/1472-6955-9-12. PMID: 20626853; PMCID: PMC2918610.