Candidal Intertrigo

Photoclinic
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A 79-year-old woman presented with this highly pruritic rash of several weeks’ duration; it had erupted under her breasts with the onset of hot weather. Initially, she treated the rash with an over-the-counter topical corticosteroid cream, which seemed to have made it worse.

Her blood glucose level was 80 mg/dL. A potassium hydroxide (KOH) evaluation and culture were positive for Candida. The rash was treated successfully with oral ketoconazole 200 mg bid for a week, plus topical econazole cream applied bid for 3 weeks.

Many patients who present with a rash that starts under the breasts simply have intertrigo. This inflammatory condition is caused in part by maceration from constant perspiration, in addition to bacterial and candidal overgrowth. Affected patients generally do not respond to treatment with antifungal medications alone; topical corticosteroids and attention to control of moisture are also required for effective therapy.

In this case, the obvious satellite lesions and positive KOH and culture helped to distinguish candidal intertrigo from the other conditions in the differential diagnosis, including contact dermatitis, irritant dermatitis, Grover disease (transient acantholytic dermatosis) and Darier-White disease (keratosis follicularis).