Synonyms.—Chafing; Intertrigo.

Definition.—Erythema intertrigo is a hyperemic disorder occur­
ring on parts where opposing surfaces of the skin come in contact, and is
characterized by redness, to which may be added an abraded surface
and maceration of the epidermis.

Symptoms.—The skin of the involved region gradually becomes
hyperemic, and may be attended by a feeling of heat, tenderness, or
soreness. As a rule, there is no elevation or infiltration. If the con­
dition is long continued and there are increased warmth and perspiration

148

HYPEREMIAS

and resulting moisture of the parts, a variable amount of maceration of
the epidermis and a mucoid discharge occur. If persistent or neglected
or if too vigorously treated, actual inflammation of a superficial character
may eventually result, and the mucoid discharge may become somewhat
purulent. In fact, in some such instances the erythema gradually changes
into a true eczema. The disease may have its seat about the nates and
genitalia, in the axillary region, folds of the neck, perineum, or beneath the
mammæ; in fact, it may occur in any region where opposing surfaces
come together. In some instances in persistent cases superficial dermic
abscesses or boils may be superadded. In neglected cases, from acci­
dental infection, too, the simple erythemas, especially when becoming
macerated, may present erosions and almost superficial ulcerations.¹

The course is variable as to duration, depending upon the conditions
and upon persistence or disappearance of the cause.

Etiology.—The causes are usually local. It is seen chiefly in
children, especially in fat subjects, in whom friction and moisture of
contiguous parts of the body, most commonly the buttocks, genitalia,
and region of the neck, are the exciting factors. Uncleanliness or the
reverse—the too free use of soap and water, especially soaps of irritating
character—will often suffice to produce the disease. In infants the
malady, when involving the genitocrural and anal regions, is frequently
due to negligence in not promptly removing wet or soiled napkins. Al­
though the exciting factors are usually external, the affection is more
frequently seen in those with stomach and intestinal disturbances. In
erythema intertrigo of the genitalia in adults diabetes mellitus may be
the predisposing and active factor (Hardy).

Diagnosis.—The disorder is rarely difficult to recognize. It is to
be distinguished from eczema, and, when it occurs about the genitalia,
from the erythema of hereditary syphilis. The difference between
erythema intertrigo and eczema is really, so far as the objective symp­
toms are concerned, one of degree. The former is, however, free from
any infiltration or thickening, and is rarely itchy; the mucoid discharge,
when present, does not stiffen linen (Crocker); and the disease disappears
promptly upon removal of the cause or after some simple mild applica­
tion.

The syphilitic erythema about the buttocks and genitalia of some
infants with hereditary syphilis (Fournier) sometimes resembles it very
closely, but this is somewhat dark in color; there is a shade of infiltra­
tion, and the color does not disappear entirely upon pressure, usually
leaving a slight yellowish tint. Moreover, there are generally other
evidences of cutaneous syphilis, more or less characteristic, upon other
parts, and other symptoms pointing to that disease. In doubtful
cases a few days’ observation would serve to establish the diagnosis—a
marked change for the better would result in erythema intertrigo, and
other developments would probably show themselves in syphilis.

¹ Some of the more recent interesting papers on these erythemas, especially as
regards the less usual and the accidental conditions, are: Jacquet, La Pratique Derma-
tologique, and Adamson, “On Napkin-region Eruptions in Infants,” Brit. Jour. Derm.,
1909, p. 37 (with several illustrations, review, and references); Ferraud, Les Dermites
des Nouveau-nês (“Érythèmes Infantiles”) Étude Histologique, Annales, p. 193, 1908.

ERYTHEMA INTERTRIGO

149

Prognosis.—As already intimated, this is always favorable. An
inquiry into the cause, followed by its correction or removal, will often
suffice. Or this, together with mild applications, will usually bring
about a cure rapidly. Any predisposing constitutional condition should
be corrected, otherwise the case may be more or less persistent, tend to
frequent recurrence, or develop into eczema.

Treatment.—The folds or parts affected are to be kept from con­
tact by means of lint or absorbent cotton, these to be frequently changed;
or by flat bags of thin cheese-cloth or similar fabric filled with a dusting-
powder (Unna). Cleanliness is absolutely essential, but it is to be kept
within the bounds of common sense. The most appropriate applications
are dusting-powders and lotions; ointments, as a rule, are not so satis­
factory, and, indeed, not infrequently aggravate. Of the dusting-
powders, boric acid, zinc oxid, talcum, and chalk are probably the most
frequently used, and may be prescribed separately or together. The
following has been of good service:

R. Pulv. ac borici,                                                     3j (4);

Pulv. zinci oxidi,                                                    3ij ( 8);

Pulv. talci,                                                             3v (20).

In persistent cases in which the epiderm has become macerated
and the discharge is somewhat offensive, a few grains of salicylic acid
may be added to the ounce of this formula. The powder should be
applied freely two or more times daily, depending upon circumstances;
the parts previously bathed gently with tepid water, and mopped dry,
occasionally using a minimum quantity of a mild, neutral soap. The
various lotions advised and employed for the treatment of the acute
types of eczema will also be useful in this disorder. Of particular value
is one composed of the following, known commonly as the “calamin-zinc-
oxid” lotion:

R. Pulv. calaminæ,

Pulv. zinci oxidi,                                             áá 3iij ( 12);

Glycerin,                                                               mnxv ( 1);

Alcoholis,                                                             f3ss ( 2);

Aquæ,                                                      q. s. ad Oss (256).

Lotions are best applied by thoroughly dabbing on several times daily;
or linen cloths may be wet with them, and kept applied for ten or fifteen
minutes, removed, and the lotion dabbed directly on the parts.

Ointments may be required in some instances, particularly in infants
who frequently soil the napkins, the layer of grease protecting the sur­
face from the irritating discharges. For this purpose zinc-oxid oint­
ment, cold cream, and Lassar‘s paste are the most acceptable.

In some instances lotions applied during the day and the ointment
at night will bring about a favorable result most quickly.

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