ConditionSkin, hair & nails
Intertrigo (Skin Fold Rash)
Intertrigo is inflammation of the skin in body folds, such as under the breasts, in the groin, armpits, belly folds, between the buttocks and between the toes. Skin rubbing on skin, trapped sweat and warmth break down the surface, causing a red, raw, itchy or burning rash that may ooze and smell. It often becomes infected with Candida yeast or bacteria. Keeping folds clean, dry and separated, plus antifungal or antibacterial creams when infection is present, clears most cases.
Also called: Intertriginous dermatitis, skin fold dermatitis, chafing rash
At a glance
- What it is
- Inflammation where two skin surfaces rub together.
- Common sites
- Under breasts, groin, belly folds, armpits, buttock cleft, neck folds in infants, between toes.
- Causes
- Friction, moisture, heat, obesity, diabetes, incontinence.
- Common infections
- Candida yeast, bacteria (strep, staph, Corynebacterium in erythrasma).
- Treatment
- Keep dry, barrier creams, antifungal or antibiotic creams, short-term mild steroid.
When to get help
See a doctor within a day or two
- A fold rash with spreading redness, warmth, swelling, pain and fever (possible cellulitis)
- Pus-filled bumps, open sores or a strong, foul smell with worsening pain
- Bright red, sharply defined rash around the anus or genitals in a child (possible strep infection)
Book a routine appointment
- A fold rash that has not improved after 2 weeks of keeping the area dry and using over-the-counter treatment
- A recurring rash in folds, especially if you have diabetes
- A shiny, well-defined red patch without satellite spots that does not respond to antifungals (possible inverse psoriasis)
Usually safe to manage at home
- Mild redness and chafing in a skin fold after heat, exercise or sweating, without signs of infection
What intertrigo looks like
- red, pink or reddish-brown patches mirroring each other on opposite sides of a fold
- raw, moist, sometimes cracked or peeling skin
- itching, burning or stinging
- an unpleasant smell when infected
- in yeast infection: bright red rash with small red bumps or pustules beyond the edge ("satellite lesions")
- in erythrasma: brownish, well-defined patches that glow coral-red under a Wood's lamp
Causes and risk factors
Intertrigo results from the combination of:
- friction between skin surfaces
- moisture from sweat, urine or stool
- heat and poor air circulation
Risk factors include:
- obesity and deep skin folds
- diabetes
- heavy sweating (hyperhidrosis)
- hot, humid weather
- urinary or fecal incontinence
- large or heavy breasts
- limited mobility or being bedbound
- tight, non-breathable clothing
- infants with neck, armpit and diaper-area folds
- weakened immune system, steroid or antibiotic use
Secondary infections
| Infection | Clues | Treatment |
|---|---|---|
| Candida (yeast) | Bright red, satellite spots, often itchy | Antifungal cream (clotrimazole, miconazole, nystatin) |
| Erythrasma | Brown, scaly, well-defined; coral-red under Wood's lamp | Topical erythromycin or clindamycin, or oral antibiotic |
| Bacterial (strep, staph) | Weeping, crusting, pustules, foul smell, pain | Topical or oral antibiotics |
| Dermatophyte (tinea) | Raised scaly edge with clearer center, often groin | Antifungal cream such as terbinafine |
Conditions that can look similar
- inverse psoriasis: smooth, shiny, sharply defined red patches
- seborrheic dermatitis: greasy, yellowish scale
- contact dermatitis from deodorants, wipes or creams
- Hailey-Hailey disease, a rare inherited blistering condition of folds
- rarely, extramammary Paget's disease, a skin cancer that looks like a persistent rash
Diagnosis
Intertrigo is diagnosed by examination. If infection is suspected, a doctor may do a skin scraping (KOH test) for yeast or fungus, a swab for bacteria, or use a Wood's lamp for erythrasma. A biopsy may be done if the rash does not respond to treatment.
Treatment
Keep the area dry and protected
- wash folds gently with mild soap and water daily; pat completely dry, or use a hair dryer on a cool setting
- separate folds with clean, dry cotton cloth or moisture-wicking textiles
- wear loose, breathable cotton clothing and a supportive bra
- apply a barrier cream (zinc oxide or petroleum jelly) to protect skin from moisture and friction
- change out of sweaty clothes promptly
- manage incontinence with prompt cleaning and barrier products
Treat infection and inflammation
- antifungal creams for yeast or fungal infection, used twice daily for 2 weeks or as directed
- topical antibiotics for bacterial infection; oral antibiotics if widespread
- mild topical steroid (such as hydrocortisone 1%) for a few days to calm inflammation, often combined with an antifungal; avoid stronger steroids in folds, where skin thins easily
- avoid powders containing cornstarch on yeast infections
Prevention
- weight loss where appropriate, which reduces skin folds
- good blood sugar control in diabetes
- daily fold hygiene and thorough drying
- absorbent powders (non-cornstarch) or antiperspirants in folds
- moisture-wicking fabrics placed in folds
Frequently asked questions
What is the best treatment for intertrigo?
Keeping the fold clean and completely dry is essential. Barrier creams protect the skin. If yeast is present, an antifungal cream such as clotrimazole works well, sometimes with a short course of mild hydrocortisone. Bacterial infection needs antibiotic treatment.
How do I know if intertrigo is infected?
Signs of infection include a bright red rash with small spots beyond its edge (yeast), pus, crusting, open sores, increasing pain, a strong smell, or spreading redness and fever. A doctor can confirm with a scraping or swab.
How long does intertrigo take to heal?
With good skin care and the right treatment, most intertrigo improves within 1 to 2 weeks. It often recurs if the underlying friction and moisture are not addressed, so ongoing prevention is important.
Why do I keep getting a rash under my breasts?
Heat, sweat and skin-on-skin contact under the breasts create ideal conditions for intertrigo and yeast. A well-fitting supportive bra, cotton liners, drying the area thoroughly and using an antifungal powder or cream when needed help prevent recurrences.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Dermatology: Intertrigo
- American Academy of Family Physicians: Intertrigo and secondary skin infections
- MedlinePlus: Intertrigo
- DermNet: Intertrigo
- NHS: Intertrigo