Source: Manual of Ambulatory Pediatrics 2010
SOAP Note – Intertrigo
An inflammatory dermatosis occurring when two moist skin surfaces in contact are in opposition.
I. Etiology
A. Skin rubbing on skin in the presence of heat and moisture leads to maceration and inflammation.
B. C. albicans can be causative agent or may be secondarily involved.
II. Incidence: Seen most often in summer, but can be present at any time of year in obese children and overdressed infants.
III. Subjective data
A. Complaints of mild to severe red rash in body folds
B. Complaints of soreness or itching
C. There may be no presenting complaint; nurse practitioner may find on routine physical examination.
IV. Objective data
A. Inspect entire body; areas most often involved in infants and children are neck creases, axillae, umbilicus, inguinal area, and crease of buttocks.
B. Mild
1. Moist
2. Mild erythema of opposing skin surfaces—almost mirror image
C. Moderate
1. Oozing
2. Moderate erythema of opposing skin surfaces
D. Severe
1. Oozing and crusting
2. May be purulent
3. Intense erythema
4. Cellulitis
5. Fissures
E. Check for regional lymphadenopathy, particularly with secondary infection.
V. Assessment: Differential diagnosis
A. Eczema: By detailed history and appearance of rash.
B. Candidiasis: By detailed history and typical appearance of moist, red, sharply demarcated borders with satellite lesions
C. Bacterial: Culture pustules, if present.
VI. Plan
A. Wash area with mild soap and water tid–qid; gently pat dry.
B. Mild to moderate
1. Caldesene Medicated Powder: Apply liberally; gently brush away excess.
or
2. Calamine lotion (soothing and drying)
C. Moderate to severe
1. Domeboro solution compresses to exudative areas tid–qid for 2 to 3 days
2. 1% hydrocortisone cream tid
D. Candidiasis
1. Nystatin cream tid or
2. If areas are very moist, nystatin powder tid
3. Domeboro solution compresses tid–qid for 2 to 3 days.
E. Secondary infection: Bactroban ointment, tid
VII. Education
A. Dry carefully after bathing.
B. With a drooling baby, keep neck dry; avoid plastic bibs.
C. Clothing
1. Use loose cotton clothing.
2. Avoid wool, nylon, synthetics.
3. Do not overdress, but use cotton undershirt to help keep body folds separated.
D. Do not let plastic on disposable diapers come in contact with skin.
E. Try to keep environment cool and dry. Use dehumidifier, fan, air conditioner.
F. Laundry
1. Use mild soap (e.g., Ivory Snow).
2. Do not use bleach or fabric softeners.
G. Powder
1. Use powder with caution to avoid inhalation by infant or child. Do not shake on from can; shake into hand and apply.
2. Do not let powder accumulate in creases.
3. Do not use cornstarch: It may be metabolized by microorganisms causing bacterial and/or fungal overgrowth.
H. Medication
1. Avoid prolonged use of corticosteroid creams.
2. Apply hydrocortisone cream sparingly.
3. Dissolve 1 packet of Domeboro powder in 1 pt of warm water; keep in covered container.
4. Use soft cloth for compresses.
I. Separate skin folds with soft cotton cloth.
J. Dietary counsel if obesity is a problem
K. Do not use occlusive, oily, or irritant ointments.
VIII. Follow-up
A. Mild
1. Telephone follow-up in 5 to 7 days
2. Return in 1 week if no improvement is noted.
B. Moderate to severe
1. Telephone follow-up in 2 to 3 days
2. Reevaluate if worse or no improvement; may require a fluorinated corticosteroid cream (e.g., Kenalog) if severely inflamed.
IX. Consultation/referral
A. No response to treatment after 2 weeks
B. Recurrent or persistent intertrigo for evaluation of diabetes
C. Cellulitis