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Intertrigo and Candida Infection – A PLAB 2 Guide

Introduction

Intertrigo is a common condition that you may encounter in both clinical practice and exams like PLAB 2. It refers to an inflammatory rash that develops in skin folds due to friction, sweat, and moisture. While intertrigo itself is not dangerous, it can easily become complicated by infections — especially with Candida albicans. Recognising the difference is key in exams and OSCE-style scenarios.


What is Intertrigo?

  • A red, sore, inflamed rash in areas where two skin surfaces rub together.

  • Common locations: under breasts, armpits, groin, buttocks, abdominal folds, between toes.

  • Exacerbated by heat, sweat, obesity, and poor air circulation.


Typical exam scenario:A patient presents with a red rash under the breast, worsens in hot weather, uncomfortable and itchy. Examiner may ask you to describe the findings and suggest management.


Causes

  1. Friction – skin rubbing against skin.

  2. Moisture – trapped sweat, urine, saliva.

  3. Heat – warm environments.

  4. Obesity – deeper folds, more sweating.

  5. Secondary infection – fungal (Candida) or bacterial.



Candida Intertrigo

When Candida infects an intertrigo rash, it takes on characteristic features.


Key Features (Think PLAB 2 buzzwords):

  • Bright “beefy red” rash.

  • Well-defined edges.

  • Satellite lesions → small red spots or pustules around the main rash.

  • Moist, sometimes white or peeling surface.

  • Itching, soreness, burning.


👉 Satellite lesions are the classic hallmark of Candida involvement. Even a single spot outside the main rash can be considered a satellite lesion.



Bacterial Superinfection

Be suspicious if you see:

  • Worsening pain, swelling, spreading redness.

  • Yellow crusts, pus, foul smell.

  • Fever or systemic signs → think cellulitis.



Complications

  • Secondary infections (fungal or bacterial).

  • Pain and discomfort affecting daily activities.

  • Skin breakdown, ulceration, hyperpigmentation.

  • Chronic or recurrent rash if underlying risk factors not addressed.



Diagnosis in PLAB 2

  • History: itching, burning, location, sweating, obesity, recurrence.

  • Examination: red moist rash in folds, check for satellite lesions.

  • Differentiate: eczema, psoriasis, tinea corporis (ringworm).

Exam tip: In OSCE, if shown a picture — always describe distribution, colour, edges, and any satellite lesions.



Management


General Care

  • Keep the area clean, cool, and dry.

  • Advise loose cotton clothing.

  • Use barrier creams (zinc oxide, petroleum jelly).

  • Encourage weight reduction if relevant.


If Candida infection suspected

  • Topical antifungal cream (clotrimazole, miconazole).

  • Continue for 1–2 weeks after rash clears.

  • For severe inflammation → mild steroid (1% hydrocortisone) + antifungal short term.


If Bacterial infection

  • Topical or oral antibiotics depending on severity.

  • Watch out for cellulitis.



Expected Course

  • Simple intertrigo: improves in 3–5 days with good care.

  • Candida: antifungal creams show improvement in about 1 week, but continue treatment for 2 weeks.

  • Without management, recurrence is common.



Key PLAB 2 Takeaways

  • Intertrigo = red sore rash in folds due to friction and sweat.

  • Candida = beefy red rash + satellite lesions.

  • Bacterial infection = spreading, pus, pain, systemic features.

  • Management = dryness, antifungal, antibiotics if bacterial, short steroid if needed.


✅ Memory Aid (PLAB 2 Mnemonic): "FMS" for Intertrigo

  • Friction

  • Moisture

  • Secondary infection (Candida/Bacteria)


📌 References:

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