A 46-Year-Old Obese Man with a Painful Skin Lesion

Differential Diagnosis

• Intertrigo
• Irritant contact dermatitis
• Candidiasis
• Stasis dermatitis

Diagnosis

This patient has intertrigo, a chronic inflammatory condition of approximating or opposing skin surfaces (intertriginous skin) such as the axillae, groin, inframammary folds, abdominal folds, and/or labiocrural folds. It is induced or exacerbated by any conditions causing increased heat, wetness, and friction and may be worse during hot or humid weather.

Learnings/What to Look for

• Intertrigo is often complicated by superficial skin infection with yeast or bacteria. In candidal intertrigo, the presence of outlying satellite papules and/or pustules is diagnostic
• Clinically, there is erythema and sometimes maceration, erosions, or fissuring
• The affected areas may itch or burn
• Intertrigo is most frequently seen in obese and/or diabetic patients
• Incontinence is a predisposing factor in intertrigo of the perineum and crural folds, and there is significant overlap with diaper dermatitis

Pearls for Urgent Care Management and Considerations for Transfer

• Mild cases of intertrigo can be treated by keeping the area dry and exposed to air
• Topical steroid cream may be necessary in more severe cases, or when exposing the area to air is not feasible
• Antifungal powder may be helpful in keeping the affected area dry

Acknowledgment: Image and case provided by VisualDx (www.VisualDx.com/JUCM).