Rash and Lesions
Rashes are commonly seen and sometimes hard to diagnose. For this discussion, describe a rash or skin lesion that presents to your clinic. If your diagnosis is bacterial, I want your two differentials to be two different origins such as fungal and viral. For example: If the patient is diagnosed with tinea corporis (fungal), your differentials might be Lyme disease (arthropod) and eczema (inflammatory).
Your answer needs to include how they are similar but, more importantly, how you differentiate one from the other. Include a complete description (size, shape, distribution, borders, and color), onset, associated symptoms (pain, fever, pruritis, and drainage), etiology, patho, and treatment of just the final diagnosis.
Rash and Lesions
M.A, a 28-year-old Black American female early this morning, presented in the clinic having complaints of rashes in her neck, armpits, and between her breasts. She said that these rashes had begun for the past two weeks. M.A. says that she does jogging exercises every morning, and she admits that her rashes get worse when they contact with sweat upon jogging. After completing the diagnosis, I ruled out Intertrigo following the clinical presentation. Intertrigo is a rash that generally affects folds of skin, where skin rubs together or where it’s often wet (Pugliese, 2018). The rubbing may cause a breakdown in the top layers of skin, triggering inflammation and rash. Usually, it looks like reddish rash. It may be characterized by a red or reddish-brown rash appearing anywhere the skin rubs together either between the toes, in armpits, on underside of belly or breasts and in the neck.
Intertrigo itself isn’t an infection. It is an inflammatory skin disorder. Though, Intertrigo over and over again leads to bacterial or fungal infection. This is identified as a secondary infection. Thus, differential diagnosis I chose would be Atopic Dermatitis and Scabies.
Similarity and Difference
Atopic dermatitis is a disorder that makes an individual’s skin itchy and red. It’s characterized by oval or round i.e., nummular well-demarcated lesions. It’s similar to Intertrigo because it presents with the same signs of painful patches, especially on hands, feet, ankles, neck, wrists, and upper chest. In difference, Intertrigo is classified in inflammatory and infectious origins, though often they overlap. Infections have a tendency to be asymmetrical and unilateral. Atopic dermatitis usually is symmetrical and bilateral, affecting neck, elbows, and knees flexures. Scabies is an itchy skin disorder triggered by a tiny burrowing mite known as Sarcoptes scabiei. Scabiei mites remain under 0.5 mm in size and are whitish brown in color. This condition is similar to Intertrigo since it presents with severe pain in the armpits, around the waist, around the breasts, and on the soles of feet (Gisondi, Bellinato & Girolomoni., 2020). Scabies differs from Intertrigo because it is triggered by the mite Sarcoptes scabiei var. hominis, an oblige human parasite that lives in the burrowed tunnels in stratum corneum.
Intertrigo Etiology and Pathophysiology
Mechanical factors and the secondary infections are a landscape triggers of intertrigo. Heat with the infusion plays key part in enabling this particular process. Skin folds the battle continuous frictional forces creating irritation and sometimes, corrosions to irritated skin. Additionally, the moisture forms in infected intertriginous parts, developing feeding base for the secondary infection to develop. The candida species flourish in heated, high-moisture zones and are usual offenders of secondary infection in intertrigo cases. Furthermore, those affected by diabetes mellitus have improved levels of P.H. in the intertriginous areas leading to the demographic occurrence. Though it’s not rare to see gram-positive and negative bacteria, the rest of the viruses and fungi account for some cases of secondary infection.
Liu & Ko. (2018) reveal that environmental factors and the genetic triggers play key role in intertrigo development. One of the factors is friction triggered by contiguous skin surfaces triggering inflammation of epidermis. Furthermore, flexural surfaces has high surface temperature related to other parts of body. Sweat and moisture forms confined in these parts add to the maceration of stratum corneum and epidermis. Moreover, integumentary system houses yeast and bacteria that show in this setting and develop in these conditions, creating the infections common finding.
Treatment for Intertrigo
I would prescribe clotrimazole cream to be used twice a day for 2-4 weeks. It would be good instructing the patient to apply Clotrimazole in the affected area and on the skin only. I also can inform her that just a strip of cream roughly 0.5 cm long would be sufficient to treat the area size of her hand. In case she doesn’t get well, she should visit for more checkup.
Gisondi, P., Bellinato, F., & Girolomoni, G. (2020). Topographic differential diagnosis of chronic plaque psoriasis: challenges and tricks. Journal of Clinical Medicine, 9(11), 3594. https://doi.org/10.3390/jcm9113594
Liu, C., & Ko, M. J. (2018). Malignant intertrigo. CMAJ, 190(19), E595-E595. DOI: https://doi.org/10.1503/cmaj.180078
Pugliese, D. J. (2018). Intertrigo. In Inpatient Dermatology (pp. 391-393). Springer, Cham. https://doi.org/10.1007/978-3-319-18449-4_79