Perineal Excoriation (Intertrigo): Causes, Treatment, and Prevention

Perineal excoriation (intertrigo) is inflammatory dermatitis of opposing skin folds in the perineum—caused by moisture, friction, and microbial overgrowth.

Etiology

• Moisture: Urine, feces, sweat, wound exudate—macerates stratum corneum.
• Friction: Skin-on-skin or clothing rubbing—disrupts barrier.
• Microbes: Candida albicans (most common), bacteria (Staph, Strep) colonize damaged skin.
• Predisposing factors: Incontinence, obesity, diabetes, immobility, tight synthetics, antibiotics, chemotherapy.

Clinical Presentation

Erythema, maceration, fissuring, satellite pustules (Candida), burning, pruritus, pain with wiping/contact.

Management

1. Eliminate triggers: Frequent incontinence care, air exposure, loose cotton underwear.
2. Barrier protection: Zinc oxide, petrolatum, dimethicone creams at each change.
3. Antifungal/antibiotic: Topical nystatin, clotrimazole, or mupirocin if infected.
4. Low-potency steroid: Hydrocortisone 1% short-term for inflammation (avoid chronic use).

Prevention

Structured skin care protocol: cleanse with pH-balanced cleanser, pat dry, barrier cream, reposition q2h if immobile. Monitor high-risk patients daily.