Intertrigo in patients with diabetes
Pro Research Analysisby 
Searched over 200M research papers
Intertrigo and Diabetes: Prevalence and Risk Factors
Intertrigo, an inflammatory condition of skin folds, is notably more common in people with diabetes. Studies show that diabetes mellitus is a significant risk factor for developing intertrigo, especially in areas such as the inguinal region, submammary folds, and gluteal clefts. Other factors that increase risk include high body mass index (BMI), female sex, urinary incontinence, and care dependency, with diabetic patients in home care and aged care facilities being particularly vulnerable 34. The presence of diabetes not only increases the likelihood of intertrigo but also contributes to its persistence and recurrence 158.
Pathogenesis and Complications in Diabetic Patients
In diabetes, skin’s protective mechanisms are often compromised, making it easier for infections to develop in areas affected by intertrigo. The condition is frequently caused or worsened by fungal (especially Candida albicans) and bacterial infections. Diabetic neuropathy, which affects a large proportion of diabetic patients, further increases susceptibility to these infections. Intertrigo in diabetic patients can lead to severe complications, including secondary bacterial infections such as cellulitis, erysipelas, abscesses, and even osteomyelitis, all of which can significantly reduce quality of life and mobility 1256.
Microbiological Profile: Fungal and Bacterial Infections
Fungal infections, particularly those caused by Candida albicans, are the most common pathogens found in intertrigo among diabetic patients. Other fungi, such as Fusarium and dermatophytes, are also implicated. Bacterial infections, especially with Gram-negative bacilli (like Escherichia coli, Pseudomonas aeruginosa, Klebsiella spp., and Proteus spp.) and Gram-positive cocci (such as Streptococci and Staphylococcus aureus), are frequently isolated from intertrigo lesions in diabetic patients. Many of these bacteria show multi-drug resistance, making treatment more challenging 67.
Diagnosis and Management Strategies
Diagnosis of intertrigo in diabetic patients is primarily clinical, but laboratory tests can help confirm the presence of fungal or bacterial pathogens, especially in recurrent or treatment-resistant cases. Management focuses on identifying and correcting predisposing factors, such as improving glycemic control, weight loss, and addressing hygiene needs. Topical antifungals (nystatin, azoles) are commonly used, and in resistant cases, systemic agents may be necessary. Cryotherapy has also shown promise as a safe and effective treatment for chronic, recalcitrant intertrigo, particularly when standard topical therapies fail 158.
Prevention and Patient Education
Preventive strategies are crucial for diabetic patients at risk of intertrigo. These include maintaining good skin hygiene, keeping skin folds dry, managing blood sugar levels, and educating patients about proper skin care. Expanding patient education, especially in diabetes care programs, can help reduce the incidence and complications of intertrigo 13.
Conclusion
Intertrigo is a common and potentially serious skin problem in patients with diabetes, often complicated by fungal and bacterial infections. Effective management requires a combination of medical treatment, risk factor modification, and patient education to prevent recurrence and improve quality of life.
Sources and full results
Most relevant research papers on this topic