Groin and inframammary dermatitis




5: Groin and inframammary dermatitis


Abstract:



Rashes of the groin and breasts are of unique significance, given the sexual and cultural meanings of these areas. This is especially true of rashes affecting the groin because many patients with noninfectious groin rashes are concerned that they may have a sexually transmitted infection. This chapter reviews several common nonsexually transmitted groin and breast rashes, including intertrigo, erythrasma, lichen sclerosus, Hailey-Hailey disease, and fixed drug eruption.

Key terms:


Intertrigo


candidiasis


inverse psoriasis


Hailey-Hailey disease


fixed drug eruption


lichen sclerosus


lichen sclerosus et atrophicans


erythrasma



Intertrigo


Shivani Sinha, Gloria Lin, and Katalin Ferenczi


Clinical features


Intertrigo is an inflammatory condition commonly found in the intertriginous skin folds and flexures. It can be caused by multiple different conditions within the inflammatory and infectious categories. Many healthcare providers use the word “intertrigo” synonymously with candida intertrigo (CI), so for simplicity, this chapter will mainly focus on intertrigo secondary to infection.


The intertriginous areas are susceptible to friction and excess moisture, leading to subsequent maceration and weakening of the epidermis, which increases the risk for secondary fungal and bacterial infections. This condition is often seen in the geriatric and disabled population or anyone who is bedridden with limited mobility. Other risk factors include obesity; hyperhidrosis; poor hygiene; incontinence; immunocompromised states (e.g., diabetes, HIV); excess irritation in the area (e.g., recurrent allergic contact dermatitis [ACD]); and hot, humid climates.



Differential diagnosis


The differential diagnosis for intertrigo includes inverse psoriasis, tinea cruris, erythrasma, ACD, and seborrheic dermatitis.





Work-up


Intertrigo is a clinical diagnosis based on a physical examination and history. A skin biopsy may be done to exclude other potential conditions but is generally not indicated.



Initial steps in management


The most important step in management is elimination of aggravating factors because this can alleviate the severity of the intertrigo and potentially prevent recurrences. It is important to counsel patients because they may be frustrated by the chronic nature of the condition and the multiple relapses.



CI or other associated fungal infections should be treated using topical antifungals. Creams are generally preferred for an active infection, whereas the powder may be useful as maintenance therapy to prevent recurrences.



Secondary bacterial infections should be treated promptly to avoid further complications.



If the treatment response is inadequate, reconsider the diagnosis and refer to dermatology for further evaluation.


Warning signs/common pitfalls




Counseling


You have a condition called intertrigo, which is caused by friction, moisture, and lack of ventilation in the folds of your skin. Maintaining proper hygiene and keeping the areas dry can alleviate your symptoms and prevent the risk for recurrent infection. Use gentle cleansers to keep the area clean and apply powder to keep the folds dry while exposing the skin to air as much as possible. Apply antiperspirants, wear loose-fitting cotton clothing, and avoid excessive heat to minimize irritation and sweating because these may exacerbate your condition. Creams containing zinc oxide can be used to create a physical barrier and reduce friction. If you have diabetes, maintaining tight control of your blood sugar can decrease the risk for intertrigo and secondary infection. In addition, maintaining a healthy weight can also be beneficial.


Contact your healthcare provider if the affected areas start to ooze or develop a foul smell because these are potentially signs of a superimposed infection that may need to be treated with antibiotics or topical creams.


Inverse psoriasis (see chapter 3, “psoriasis”)



Tinea cruris (see chapter 3, “tinea corporis”)



Erythrasma


Campbell Stewart


Clinical features


Erythrasma is caused by the gram-positive bacillus Corynebacterium minutissimum, which infects the most superficial layer of the skin, the stratum corneum. C. minutissimum is a normal inhabitant of the skin; in the setting of excess heat and moisture, however, it can pervade the intertriginous sites of the body. Other contributing factors include obesity, diabetes, hyperhidrosis, lack of hygiene, and immunosuppression. Deeper/systemic infections by this bacterium are exceedingly rare outside of the setting of immunosuppression.



Differential diagnosis


The main clinical differential diagnoses are tinea corporis/pedis/cruris, intertrigo, cutaneous candidiasis, tinea versicolor, and seborrheic dermatitis. Complicating matters, the bacterial and fungal diseases can coexist, as will be discussed in a later section. Inverse psoriasis is also in the differential.


Jul 22, 2021 | Posted by in Dermatology | Comments Off on Groin and inframammary dermatitis
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