Can you identify this chronic malodorus rash?

December 7, 2009

Case 4: An obese 59-year-old man presents with a chronic malodorous, itchy rash in his groin.

Case 4:
An obese 59-year-old man presents with a chronic malodorous, itchy rash in his groin.

Can you identify this rash?

A. Tinea cruris.
B. Candidiasis.
C. Erythrasma.
D. Intertrigo.
E. Seborrhea.
F. Psoriasis.

Case 4: Intertrigo

Obesity predisposed this patient to intertrigo, D. This inflammatory condition of the skin folds is induced or aggravated by heat, moisture, maceration, friction, and lack of air circulation. Secondary infection- as occurred in this patient-is common; it usually is candidal, but it can be bacterial, viral, or other fungal infection.

The axillae, perineum, inframammary creases, and abdominal folds are the most common sites of involvement. The apposed skin surfaces rub against each other, causing erosions that become inflamed. Sweat, feces, urine, and vaginal discharge may aggravate intertrigo in both adults and infants.

The key to treatment is to eliminate friction, heat, and maceration by keeping the skin folds cool and dry. Antimycotic agents (miconazole, clotrimazole) may be helpful, especially if they are used with a mild- to midpotency (class III to VI) corticosteroid for a short duration. Avoid stronger topical corticosteroids because the occlusive effect of skin folds can accelerate the development of skin atrophy and striae.

Formulations that combine protective agents, antimicrobials, and topical corticosteroids may be helpful. One example is Triple Paste, which includes petrolatum, zinc oxide paste, and aluminum acetate (Burow) solution. A thick coat of these protective barrier creams should be applied. Commercially available barrier pastes that are used for diaper dermatitis (eg, Desitin) can also be helpful.