Case studies
3-month old infant
A 3-month old infant presented with streptococcal intertrigo after experiencing a rash in their groin area for 3 days. A bright, distinct red coloration was evident in the infants skin folds, which were also moist and wrinkly. A bacterial sample was collected and tested on with antibiotics. The infant was initially treated with oral flucloxacillin which proved to be effective in clearing the bacteria. From the culture, the bacteria was classified as a group A beta-hemolytic streptococci. 5-month old male
A 5-month old infant with a history of eczema presented with a dark red rash on their ear, neck and lower limbs. They were initially diagnosed with intertrigo due excessive drooling and were prescribed a course of antifungal topical powder. The infant returned to the pediatrician a week later because the rash had gotten worse and their eczema was greatly exacerbated. A skin culture was done as it was suspected that the rash was due to a bacterial infection instead. Streptococcus pyogenes was the predominant growth found in the culture. The patient was prescribed a cephalexin suspension and a dexamethasone suspension, which resolved the inflammation after 3 weeks. 2-year old female
A 2-year old female presented with a well-demarcated red, smooth plaque, foul smell, and no satellite lesions on the left armpit and neck for 2 weeks. They were initially treated for candidal intertrigo without improvement in their condition. The affected areas were swabbed, and the culture grew group A beta-hemolytic Streptococcus pyogenes that was sensitive to penicillin.
It is also helpful to expose such areas to air and limit skin-on-skin friction as much as possible. In order to decrease friction as a predisposing factor, weight loss for individuals with obesity or reduction mammoplasty for large breasts is encouraged and recommended. To decrease the chance of worsening symptoms, a drying agent, such as baby powder, can be applied. Application of other barrier agents, such as zinc oxide or petrolatum, aids in the reduction of skin deterioration and alleviates itching and pain. Treatment
The most common treatment options of intertrigo complicated with secondary bacterial infection such as group A beta-hemolytic streptococcus are topical mupirocin (bactroban), erythromycin, low potency topical steroids like hydrocortisone 1% cream, and oral antibiotics (such as oral penicillin, cephalexin, ceftriaxon, cefazolin, and clindamycin). These broad-spectrum antibiotics are ideal in targeting bacterial agents due to the large number of microbiota on the human skin. Additionally, the low potency steroids aid in the reduction of the reaction, reducing discomfort to the patient. Drying agents, such as aluminum sulfate and talcum powder, may be used alongside other treatments to help the healing process to go faster. Although, if these agents are to be used, it is better to space them few hours apart. A hair drier could also be utilized on the affected area as intertrigo responds well to the removal of moisture. Age is an important factor to consider when dosing since intertrigo is prevalent amongst young children. Proper identification of etiology is required in order to treat optimally.