# Intertrigo - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: AAD Guidelines for Management of Superficial Cutaneous Infections 2020 · Intertrigo - StatPearls - NCBI Bookshelf (NBK531489) - disease-level clinical article (intertrigo-full.txt) · Egyptian National Drug Formulary - Antimicrobial 2023 (clotrimazole monograph) · Egyptian National Drug Formulary - Antimicrobial 2023, mupirocin monograph · Egyptian National Drug Formulary - Antimicrobial 2023, flucloxacillin monograph · Hydrocortisone Cream 1% w/w SmPC sections 4.1 and 4.2 (eMC product 13103) · No labelled dose - barrier preparation applied to intact skin, to effect - Verified date: 2026-08 ## Verified against - No labelled dose - barrier preparation applied to intact skin, to effect - Egyptian National Drug Formulary - Antimicrobial 2023 (clotrimazole monograph) - Intertrigo - StatPearls - NCBI Bookshelf (NBK531489) - disease-level clinical article (intertrigo-full.txt) - Egyptian National Drug Formulary - Antimicrobial 2023, mupirocin monograph - Egyptian National Drug Formulary - Antimicrobial 2023, flucloxacillin monograph - Hydrocortisone Cream 1% w/w SmPC sections 4.1 and 4.2 (eMC product 13103) ## Treatment metadata - Zinc oxide — topical - Clotrimazole — topical - Mupirocin — topical - Flucloxacillin — 250 mg — oral.solid - Fluconazole — 150 mg — oral.solid - Hydrocortisone — topical ## Complete treatment card ```text INTERTRIGO Sources: AAD Guidelines for Management of Superficial Cutaneous Infections 2020 · Intertrigo - StatPearls - NCBI Bookshelf (NBK531489) - disease-level clinical article (intertrigo- full.txt) · Egyptian National Drug Formulary - Antimicrobial 2023 (clotrimazole monograph) · Egyptian National Drug Formulary - Antimicrobial 2023, mupirocin monograph · Egyptian National Drug Formulary - Antimicrobial 2023, flucloxacillin monograph · Hydrocortisone Cream 1% w/w SmPC sections 4.1 and 4.2 (eMC product 13103) · No labelled dose - barrier preparation applied to intact skin, to effect Review status: REVIEWED against 4 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (3) - Chronic, gradually-onset itching, burning, tingling, and pain in the skin folds [itching · tingling] - A sudden change in symptoms raises concern for a secondary infection with Candida, bacteria, or another pathogen - Heavy sweating, often from strenuous exercise, is a major contributor to the inflammation [sweating] SIGNS - what you find (6) - Exam typically shows a mildly red patch mirrored on both sides of the skin fold - Over time the red patches can progress to erosions, maceration, fissuring, crusting, and weeping [crusting · redness] - Satellite papules and pustules around the rash are considered diagnostic for candida [papules · pustules · rash] - A blue-green discoloration suggests Pseudomonas involvement - Bacterial intertrigo tends to look intensely red, weeping, and tender rather than scaly - Pustules, crusts, or vesicles on exam point toward a secondary infection [blisters · pustules · vesicles] TESTS (5) - A suspected bacterial cause can be confirmed by culturing the lesion - Fungal cause is checked with a KOH-prepped scraping from the lesion's edge - Biopsy is reserved for atypical presentations or when treatment has already failed - A Wood lamp helps pick up Pseudomonas or erythrasma infection - Recurrent or hard-to-treat cases warrant a fasting glucose check to look for underlying diabetes IF NOT THIS - what else fits (1) - Seborrheic dermatitis, contact dermatitis, atopic dermatitis, inverse psoriasis, pemphigus, and scabies can all mimic intertrigo in the folds Source StatPearls "Intertrigo" - disease-level clinical article Status traced to the source above Rx: Barrier and drying - the mainstay | Topical antifungal | Bacterial superinfection - topical | Bacterial superinfection - oral | Oral antifungal - resistant infection | Inflammation - short course BARRIER AND DRYING - THE MAINSTAY 1. ZINC OXIDE [1st line] Adult Apply protective barrier cream to clean dry skin folds twice daily - until skin fold irritation resolves Peds Apply to clean dry skin folds in children Source No labelled dose - barrier preparation applied to intact skin, to effect Why Barrier protectant that shields irritated skin-fold surfaces from the friction and trapped moisture that cause intertrigo in the first place, rather than treating an infection. Addresses the mechanical cause described in the cautions. Caution Keep skin folds clean, dry, and exposed to air where possible. Friction and moisture in inframammary, inguinal, or axillary folds are primary causes. Place cotton or absorbent material between skin folds to reduce friction. Egypt NAPI-CARE OINT. ARAB DRUG COM... 2.35 EGP PENTADIAPER 20% TOPICAL CREAM 30 GM EVA PHARMA > PENTA PHARMA 3.50 EGP BABY RASH FREE 30% OINT. ALEXANDRIA > ... 5.00 EGP EVA BABY CARE CREAM 50 GM EVA PHARMA 9.75 EGP BALMIX 10% CREAM 30 GM SIGMA 14.40 EGP NONOPENT CREAM 75 GM > PENTA PHARMA 100.00 EGP NINO SERENO CREAM EL NILE > GMCKS 120.00 EGP TOPICAL ANTIFUNGAL 2. CLOTRIMAZOLE [2nd line] Adult Apply to affected area twice daily x 2-4 weeks (continue 1 week after resolution) Peds Children ≥2 years: Apply twice daily (morning and night) for 2 weeks. Source Egyptian National Drug Formulary - Antimicrobial 2023 (clotrimazole monograph) Why Topical imidazole antifungal that disrupts the fungal cell membrane, used when intertrigo becomes secondarily infected with Candida (the fiery red rash with satellite pustules noted in the cautions). Caution AVOID potent topical corticosteroid combination creams in occluded skin folds (causes rapid skin atrophy, striae, and worsens fungal proliferation; low-potency hydrocortisone 1% may be used short-term max 7 days only for severe inflammation). Indicated when secondary Candida infection develops (fiery red rash with satellite pustules). Ensure skin fold is thoroughly dried after bathing before applying cream; advise loose- fitting cotton clothing. Sirolimus: Clotrimazole (Topical) may increase the serum concentration of Sirolimus. Egypt CANEMAZOLE 1% CREAM 20 GM UP PHARMA 5.00 EGP CANDISTAN 1% TOPICAL CREAM 15 GM KAHIRA > ARAB... 7.25 EGP DERMATIN 1% TOP. CREAM 14 GM PHARCO 15.00 EGP CANESTEN 1% CREAM 20 GM MEMPHIS > BAY... 29.00 EGP LOCASTEN 1% CREAM 20 GM ALEXANDRIA 29.00 EGP CANDISTAN 1% TOPICAL CREAM 40 GM KAHIRA > ARAB... 36.00 EGP BACTERIAL SUPERINFECTION - TOPICAL 3. MUPIROCIN [2nd line] Adult Apply 2% ointment to the affected fold twice daily - Until the rash resolves Peds Applied the same way in children - a topical dose is not weight-based. The formulary's paediatric instruction is a small amount three times daily for 5 to 10 days, with review at 5 days if there is no clinical response (Egyptian National Drug Formulary, mupirocin monograph). Source Intertrigo - StatPearls - NCBI Bookshelf (NBK531489) - disease-level clinical article (intertrigo-full.txt) for the indication - verbatim: "Topical treatments such as mupirocin or bacitracin may be effective for lesions infected with mild bacteria." Dose from the same article, the sentence that governs its topical options: "Topical treatments should be applied twice daily until the rash resolves." The 2% strength is the only mupirocin marketed in Egypt. Why The antibacterial for a fold that has become mildly infected rather than simply macerated. It is the option the source names first, and the one of the two named that is sold plain in Egypt. Caution Re-evaluate rather than repeat if there is no response after 3 to 5 days - the formulary sets that as the point to look again, not to extend the course. Spreading redness, fever, or a rapidly enlarging area is cellulitis, which the source says needs oral medication. A topical antibiotic does not cover it. Treat the moisture as well as the infection. An antibacterial applied into a wet fold leaves the cause of the rash exactly where it was. Egypt BACTROFORM 2% TOP. OINT. 15 GM WESTERN PHARM... 35.00 EGP MUPIROCIN SAJA 2% TOP. OINT. 15 GM BIOPHARM EGYPT > SAJA PHARMA 35.00 EGP MUPIRAX 2% OINT. 10 GM GLOBAL NAPI P... 48.00 EGP MUPIROCIN SAJA 2% TOP. OINT. 20 GM BIOPHARM EGYPT > SAJA PHARMA 83.00 EGP MUPIRAX 2% OINT. 30 GM GLOBAL NAPI P... 118.00 EGP BACTERIAL SUPERINFECTION - ORAL 4. FLUCLOXACILLIN [2nd line] Adult 250 mg orally four times daily; the dose may be doubled for a severe infection - The formulary states no course length for this dose - review at 5 to 7 days rather than repeating a prescription Peds Age-banded rather than weight-based by mouth: 1 month to 1 year 62.5 to 125 mg, 2 to 9 years 125 to 250 mg, 10 years and older 250 to 500 mg, all four times daily (Egyptian National Drug Formulary, flucloxacillin monograph, quoting BNFC for beta-lactamase- producing staphylococcal infection including impetigo and cellulitis). Source Intertrigo - StatPearls - NCBI Bookshelf (NBK531489) - disease-level clinical article (intertrigo-full.txt) for the indication - verbatim: "Flucloxacillin or erythromycin, which targets gram-positive bacteria such as Staphylococcus or Streptococcus, should be prescribed if oral medication is necessary." Dose from Egyptian National Drug Formulary - Antimicrobial 2023, flucloxacillin monograph - verbatim: "The usual adult dose orally or by intramuscular injection is 250 mg four times daily" and "All systemic doses may be doubled in severe infections." Why Oral cover when the fold is infected beyond what a cream reaches. Erythromycin is named alongside it in the source and cannot be dispensed in Egypt, which leaves this as the source's usable oral option. Caution No plain flucloxacillin is sold in Egypt. All 33 live products are combinations with amoxicillin or ampicillin, so the patient goes home with a second antibiotic as well - check the pack and account for it. Penicillin allergy is a contraindication. Ask about prior reactions before prescribing. Cholestatic jaundice and hepatitis are rare but real, more often with longer courses and in older patients. Egypt FLUMOCIN 250MG 12CAPS. UP PHARMA 6.20 EGP (0.52/unit) -> ! also contains amoxicillin AMOFLUX 125/125MG 12 CAPS. RAMEDA > DELT... 8.25 EGP (0.69/unit) -> ! also contains amoxicillin FLUCAMOX 250MG 12CAPS. SEDICO 8.25 EGP (0.69/unit) -> ! also contains amoxicillin FLUMOCIN 500MG 8 CAPS. UP PHARMA 6.00 EGP (0.75/unit) -> ! also contains amoxicillin CURAFLUX 125/125 MG 12 CAPS. RAMEDA > PIONEER 12.50 EGP (1.04/unit) -> ! also contains amoxicillin AMOFLUX 250/250MG 16 CAPS. RAMEDA > PIONEER 18.00 EGP (1.12/unit) -> ! also contains amoxicillin HI-FLUCIL 250/250MG 16 CAPS. CID 20.00 EGP (1.25/unit) -> ! also contains amoxicillin AMPIFLUX 500 MG 12 CAPS. PHARCO 16.00 EGP (1.33/unit) -> ! also contains ampicillin ORAL ANTIFUNGAL - RESISTANT INFECTION 5. FLUCONAZOLE [2nd line] Adult 100 to 200 mg orally once daily x 7 days Peds The source states this 7-day course for adults and gives no weight-based equivalent, so none is stated here. Source Intertrigo - StatPearls - NCBI Bookshelf (NBK531489) - disease-level clinical article (intertrigo-full.txt) - verbatim, indication and dose in one sentence: "For resistant fungal infections, oral fluconazole at a dosage of 100 to 200 mg daily for 7 days may be effective." Why For candidal intertrigo that has not settled on a topical antifungal. The source offers it for resistant fungal infection, which makes it a second step rather than a first. Caution Only after a topical antifungal has been tried. The source reserves oral fluconazole for resistant fungal infection. Fluconazole inhibits CYP2C9 and CYP3A4 and has multiple drug interactions - check the patient's other medicines, particularly warfarin and statins. Avoid in pregnancy. Recurrent or difficult intertrigo is a reason to check a fasting blood glucose. The source asks for it in exactly these patients. Egypt JENFUNGA 150 MG 1 CAPS. EGPI > JENIKO... 4.50 EGP (4.50/unit) AMRIFLUCAN 150 MG 2 CAPS. AMRIYA 11.00 EGP (5.50/unit) FLUDCONRIZOLE 150 MG 1 CAPS. RIVA PHARMA S... 6.00 EGP (6.00/unit) FLUCORAL 150 MG 4 CAPS. SEDICO 60.00 EGP (15.00/unit) TRICONAL 150 MG 1 CAPS. T3A PHARMA > ... 26.50 EGP (26.50/unit) NAVILUCA 150 MG 2 CAPS. INTERNATIONAL... 69.00 EGP (34.50/unit) NAZOWELL 150 MG 3 CAPS. EGPI > HEALTH... 108.00 EGP (36.00/unit) DIFLUCAN 150 MG 1 CAPS. PFIZER 111.00 EGP (111.00/unit) DIFLUNAZOLE 25MG/5ML SYRUP 70ML CID 28.80 EGP -> ? strength differs, ? different route - not oral solid FLUCAZONIL 25MG/5ML SYRUP 70 ML EL NILE. 28.80 EGP -> ? strength differs, ? different route - not oral solid INFLAMMATION - SHORT COURSE - give alongside 6. HYDROCORTISONE [add-on - not a substitute] Adult Apply 1% cream sparingly to the affected skin two or three times daily after gently cleansing the area - Short course only - the label limits courses in children to seven to ten days Peds Same application in children, but the label caps the course at seven to ten days. Source Hydrocortisone Cream 1% w/w SmPC sections 4.1 and 4.2 (eMC product 13103) - verbatim indication, which names this condition: "Hydrocortisone Cream is indicated for the treatment of eczema and dermatitis of all types, including atopic eczema, photodermatitis, otitis externa, primary irritant and allergic dermatitis, intertrigo, prurigo nodularis, seborrhoeic dermatitis and insect bite reactions." Dose, verbatim: "Adults and children: To be applied sparingly to the affected skin two or three times daily after gently cleansing the area. Courses of treatment in children should generally be limited to not more than seven to ten days." Clinical framing from Intertrigo - StatPearls - NCBI Bookshelf (NBK531489) - disease-level clinical article (intertrigo- full.txt) - verbatim: "Low-dose steroids, such as hydrocortisone cream, can be considered for their anti-inflammatory properties, although they are not always necessary." Why An add-on for the itch and redness while something else treats the cause. The source is explicit that it is optional, and its licence names intertrigo directly. Caution Keep the steroid weak and the course short. The source asks for a lower-strength steroid to prevent atrophy in the already thinner epidermis of the flexural surfaces, and prolonged use there causes atrophy and striae. Buy hydrocortisone acetate 1%, which is what the quoted label covers. Egyptian pharmacies also stock hydrocortisone butyrate - a different ester that the quoted label does not cover - and its 0.1% pack is not a weaker version of a 1% cream, because the percentage on the box does not compare across two different esters. A steroid alone treats the inflammation and not the organism. Give it alongside the antifungal or antibacterial, never instead of one. Egypt NOVACORTIN 1% CREAM 15 GM PHAROPHARMA 4.75 EGP NOVACORTIN 1% OINT. 15 GM PHAROPHARMA 4.75 EGP MICORT 1% CREAM 20 GM MISR 12.50 EGP HYDROCORTISONE 1% OINT. 20 GM MISR 21.00 EGP EFFICORT 0.1% LIPOCREAM 15 GM MINA PHARM > ... 8.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)