Intertrigo

Intertrigo is an inflammatory condition of skin folds, induced or exacerbated by heat, moisture, maceration, friction and lack of air circulation. Conditia este frecvent inrautatita sau colonizata de infectie, cel mai comun condidozica, dar poate fi si bacteriana, fungica sau virala. The condition is often worsened or colonized by infection, the most common condidozica, but may be bacterial, fungal or viral.

Intertrigo afecteaza comun axila, perineul, zona submamara si pliurile abdominale. Dermatita de scutec este agravata de intertrigo. Intertrigo affecting common axilla, perineum, abdominal folds and submamara area. Diaper dermatitis is exacerbated by intertrigo. Intertrigo este o complicatie comuna a obezilor si diabeticilor. Intertrigo is a common complication of obese and diabetic.
Afectiunea este sezonala asociata cu caldura si umiditatea, sau activitati in care intervine frictiunea pielii. Aspectul este dependent de zona de piele afectata si de durata inflamatiei. Eritemul poate progresa la maceratie si crustificare. The condition is associated with seasonal heat and humidity, or activities in skin friction occurs. Is dependent upon the appearance of skin affected and the duration of inflammation. Erythema may progress to maceration and crustificare. Pot apare pustule si vezicule care sa indice infectia. There may be pustules and blisters that would indicate infection.

Tratamentul include mentinerea pliurilor curate, uscate, se plaseaza o compresa uscata intre acestea . Treatment includes keeping folds clean, dry, place a dry dressing in between. Se folosesc antifungici topici: clotrimazole, miconazole. Use topical antifungals: Clotrimazole, miconazole.

Patogenie si cauze Pathogenesis and causes

Intertrigo se dezvolta pri factori mecanici si infectie secundara. Intertrigo to develop parts and mechanical factors secondary infection. Caldura si maceratia sunt procesul central. Heat and soak are processed centrally. Suprafetele de piele opozante se freaca una de cealalta, determina eroziuni care devin inflamate. Transpiratia , fecalele, urina si debaclurile vaginale pot agrava intertrigo la adulti si copii. Opposing skin surfaces rub against each other, cause erosion, which become inflamed. Sweat , feces, urine and vaginal discharge may aggravate intertrigo debaclurile in adults and children.

Semne si simptome Signs and symptoms

Intertrigo afecteaza persoane care sunt virstnice sau foarte tinere datorita imunitatii reduse, imobilizarii si incontinentei. De obicei este cronic cu debut insidios cu prurit, senzatie de arsura in pliurile pielii. Cind se noteaza discomfortul acut este considerata infectia secundara. Intertrigo este a afectiune sezonala, asociata cu caldura si umiditatea sau activitatea in care pliurile pielii sunt frictionate. Factori de risc sunt diabetul zaharat , obezitatea si hiperhidroza . Intertrigo affect people who are elderly or very young because of reduced immunity, immobilization and incontinence. It is usually chronic with insidious onset of itching, burning sensation in skin folds. Rateable When secondary infection is considered acute discomfort. Intertrigo is a seasonal disease, associated with the heat and humidity or activity in the skin folds are frictional. Risk factors are diabetes mellitus , obesity and hyperhidrosis . Alti factori care predispun la intertrigo perineal sunt incontinenta urinara sau fecala, debaclurile vaginale sau o rana supurata. Other factors that predispose to perineal intertrigo are urinary incontinence or fecal, or vaginal debaclurile wound effusion.

Examen fizic Physical Exam
Aspectul pielii afectate este dependent de zona si de durata inflamatiei. Eritemul poate progresa la macerare si crustificare. The appearance of skin affected is dependent on location and duration of inflammation. Erythema may progress to maceration and crustificare. Fisurile pot determina eroziuni. Cracks can cause erosion. Pustulele si veziculele pot indica infectie. La perineu afectarea profunda a pliurilor tegumentului sunt comparate cu dermatita de scutec in care doar suprafetele convexe sunt implicate. Pustules and vesicles may indicate infection. Perineal damage deep in the skin folds compared with diaper dermatitis in which only the convex surfaces are involved.
Poate fi afectat orice pliu cutanat in intertrigo. La adultii sau copiii care sunt obezi, pliurile cutanate sunt accentuate iar inflamatia poate apare sub pliurile abdominale, pliurile gitului, fosa antecubitala sau popliteala. May be affected in any skin fold intertrigo. In adults or children who are obese are increased skin folds and inflammation may occur in the abdominal folds, neck folds, antecubital or popliteal fossa.
Complicatiile posibile cuprind celulita , dermatita de contact prin agentii topici aplicati. Possible complications include cellulitis , contact dermatitis with topical agents applied.
Diagnostic Intertrigo Diagnosis intertrigo
Studii de laborator: Laboratory studies:
-testul la hidroxid de potasiu, colooratia Gram, cultura este utila pentru a exclude infectia primara sau secundara si ghidarea terapiei -Test potassium hydroxide, Gram colooratia culture is useful to exclude primary or secondary infection and guiding therapy
-examinarea cu lampa Wood exclude eritrasma Wood-lamp examination excluded eritrasma
-se vor efectua teste specifice daca pacientul este diabetic, prezinta acrodermatita enteropatica , eritem migrator necrolitic secundar glucagonomului sau intertrigo se vindeca greu. -Specific tests will be performed if the patient is diabetic, has acrodermatitis enteropathy , necrolitic migratory erythema intertrigo secondary glucagonomului or difficult to heal.

Biopsia de piele poate excude psoriazisul invers, boala Bowen , boala Paget sau carcinomul metastatic. Skin biopsy can exclude psoriasis conversely, Bowen disease , Paget's disease or metastatic carcinoma.
Diagnosticul diferential se face cu urmatoarele afectiuni: acantosis nigricans, acrodermatita enteropatica, boala Bowen, candidoza mucoasei, celulita, dermstita de contact, alergica, iritanta, eritrasma, granulomul gluteal infantil, impetigo , scabia , dermatita seboreica , sifilis. The differential diagnosis is made with the following conditions: acanthosis nigricans, acrodermatitis enteropathy, Bowen's disease, candidiasis mucosa, cellulitis, contact dermstita, allergic, irritating, eritrasma, granuloma gluteal infantile ringworm , scabies , seborrheic dermatitis , syphilis.

Tratament Intertrigo Treatment intertrigo

Se va elimina frictiunea pliurilor, caldura si maceratia prin mentinerea uscata si racoroasa a zonelor. Se pot folosi pudre absorbante s i expunerea pliurilor la aer. Compresele cu solutie Burow, otetul diluat sau pliculetele de ceai umede sunt eficiente, mai ales urmate de expunere la aer. It will remove creases friction, heat and soak by keeping areas dry and cool. You can use the absorbent powder and folds and exposure to air. Compresses with Burow solution, diluted vinegar or wet tea bags are effective, especially followed by exposure to air.

Suprafetele de piele din faldurile profunde pot fi tinute separate printro compresa de bumbac sau in uscata, se vor evita hainele strimte, elastice. Se indica folosirea de agenti antifungici (miconazole, clotromazole) alaturi de un steroid de clasa IV-VI (tacrolimus) pentru o perioada scurta. Deep folds of skin surfaces can be kept separate through a cotton compress or dry clothes will avoid narrow, flexible. It indicates the use of antifungal agents (miconazole, clotromazole) with a steroid class IV-VI (tacrolimus) for a short period. Se vor evita steroizii puternici topici deoarece efectul ocluziv al pliurilor de piele poate accelera dezvoltarea atrofiei cutanate. Potent topical steroids should be avoided because the effect of occlusive skin folds can accelerate the development of skin atrophy.

Formulele care combina agenti protectivi, antimicrobieni si steroizi topici includ: Formulas combining protective agents, antimicrobials and topical steroids include:
-vopseaua Castellani: carbol-fucsina Castellani-paint: carbolic-magenta
-pasta tripla: petroleum, oxid de zinc si acetat de aluminiu (solutie Burow) Triple-paste: petroleum, zinc oxide and aluminum acetate (Burow solution)
-Greer Goo : nistatin, hidrocortizon si oxid de zinc pasta. Goo-Greer: nystatin, hydrocortisone and zinc oxide paste.
Se indica folosirea de sandale pentru a diminua umezeala interdigitala. It indicates the use of sandals to reduce moisture interdigital.
Cu terapie progosticul fiecarui episod de intertrigo simplu este excelent. With each episode of care progosticul simple intertrigo is excellent. Recurenta este frecventa. Recurrence is common.