DermAtlas: Online Dermatology Image Library dermatology image,erythrasma,intertrigo,streptococcal infection,intertrigo, streptococcal,dermatitis, seborrheic,dermatitis, seborrheic,candidiasis,dermatitis, diaper,Gram negative infection,Pseudomonas aeruginosa infection,toe web infection

© 2001-2010, DermAtlas	*Image Name:*	erythrasma_2_060501	*File Type:*	jpg
	*Diagnosis:*	ERYTHRASMA / INTERTRIGO	*Category:*	infections and infestations
	*Body Site:*	axilla (armpit)	*Age:*	41 years
	*Contributor:*	Naeem Alhayani, DVD
	*Description:*	symmetric brown minimally scaly intertriginous patches
	*Comments:*	This 41-year-old obese man complained of itchy brown patches in the groin and armpits. When examined with a Wood light they showed coral red fluorescence.

© 2001-2010, DermAtlas	*Image Name:*	streptococcal_intertrigo_1_050114	*File Type:*	jpg
	*Diagnosis:*	STREPTOCOCCAL INFECTION / INTERTRIGO / INTERTRIGO, STREPTOCOCCAL	*Category:*	infections and infestations / intertriginous rashes
	*Body Site:*	groin / diaper area	*Age:*	0
	*Contributor:*	Paul Honig, MD
	*Description:*	symmetric sharply demarcated, beefy-red scaly macerated plaques
	*Comments:*	A 5-month-old girl had an 8-week history of a persistent foul smelling intertriginous eruption involving the neck, axillae, groin, and flexural creases of the arms and legs. Lesions were unresponsive to topical and oral nystatin for presumed candidal intertrigo. Culture yielded heavy growth of a single organism (Group A beta-hemolytic Streptoccus). Group A beta-hemolytic streptococci (GABHS) produce a variety of skin infections, including cellulitis, ecthyma, erysipelas and perianal cellulitis in young children. Another streptococcal skin infection – GABHS intertrigo – represents an under-recognized cause of intertriginous eruptions in children. Simple intertrigo results from the friction created by opposing skin surfaces and is exacerbated by moisture trapped in deep skin folds. Young infants are especially susceptible due to their relative chubbiness, short necks, and flexed posture, all of which lead to deep skin folds. Secondary infection by Candida albicans is not uncommon; however, other secondary pathogens, such as GABHS, should also be considered. Other bacteria reported to occur in mixed infections include Pseudomonas aeruginosa and Proteus vulgaris or P. mirabilis. Certain clinical features may help to differentiate monilial intertrigo from GABHS intertrigo. Although present in both settings, satellite lesions favor Candida infection, whereas the presence of a distinct, foul smell on examination suggests GABHS intertrigo. GABHS skin infections may also induce psoriasiform skin lesions or may be associated with psoriasis, which present as scaly, erythematous islands that can resemble satellite lesions. Culture of the affected skin areas provides the most definitive tool to differentiate these two conditions. Some suggest the use of a rapid strep test to help with prompt diagnosis; however, the specificity and sensitivity of the technique for this anatomic site remains to be determined. Simple intertrigo responds to measures that minimize moisture and reduce friction, such as barrier creams or absorptive powders such as cornstarch. Candidal intertrigo responds to anti-yeast preparations such as econazole, ketoconazole, or nystatin creams or ointments. A 10-day course of properly dosed penicillin successfully treats GABHS in most instances. For less-severe cases, a trial of topical mupirocin ointment can be utilized. Frequently, use of a low-potency topical steroid is helpful for decreasing inflammation and its associated symptoms. References: 1. Amren DP, Anderson AS, Wanamaker LW. Perianal cellulitis associated with group A streptococci. Am J Dis Child. 1996;112:546-552. 2. Esterly NB, Markowitz M. The treatment of pyoderma in children. JAMA. 1970;212:1667-1670. 3. Honig PJ. Gutt ate psoriasis associated with perianal streptococcal disease. Arch Dermatol. 1998;124:702-704. 4. Honig PJ, Frieden IJ, Kim HJ, Yan AC. Streptococcal Intertrigo: An Underrecognized Condition in Children. Pediatrics 2003;112:1427-29. 5. Koky NP, Cornstock JA, Facklam RR. Streptococcal perianal disease in children. Pediatrics. 1987;80:659-663. 6. Leyden J, Kligman AM. The role of microorganisms in diaper dermatitis. Arch Dermatol. 1978;114:56-59.

© 2001-2010, DermAtlas	*Image Name:*	Intertrigo_1_040702	*File Type:*	jpg
	*Diagnosis:*	INTERTRIGO	*Category:*	papulosquamous eruptions / vesiculobullous eruptions
	*Body Site:*	hand / web space, hand	*Age:*	36 years
	*Contributor:*	Kosman Sadek Zikry, MD
	*Description:*	erythematous erosions with well defined scaly border
	*Comments:*	This 6-year-old boy developed chronic recurrent maceration and erosions of several finger web spaces.

© 2001-2010, DermAtlas	*Image Name:*	Intertrigo_1_040613	*File Type:*	jpg
	*Diagnosis:*	DERMATITIS, SEBORRHEIC / INTERTRIGO	*Category:*	papulosquamous eruptions / vesiculobullous eruptions
	*Body Site:*	ear	*Age:*	6 years
	*Contributor:*	Kosman Sadek Zikry, MD
	*Description:*	symmetric red scaly, crusted macerated patches
	*Comments:*	This healthy 6-year-old girl developed recurrent itchy patches behind her ears and in the groin. The lesions improved with compresses and topical steroids.
	*Related Images:*	Intertrigo_2_040613

© 2001-2010, DermAtlas	*Image Name:*	Intertrigo_2_040613	*File Type:*	jpg
	*Diagnosis:*	DERMATITIS, SEBORRHEIC / INTERTRIGO	*Category:*	papulosquamous eruptions / vesiculobullous eruptions
	*Body Site:*	ear	*Age:*	6 years
	*Contributor:*	Kosman Sadek Zikry, MD
	*Description:*	symmetric red scaly, crusted macerated patches
	*Comments:*	This healthy 6-year-old girl developed recurrent itchy patches behind her ears and in the groin. The lesions improved with compresses and topical steroids.
	*Related Images:*	Intertrigo_1_040613

© 2001-2010, DermAtlas	*Image Name:*	tinea_manus_intertrigo_2_040613	*File Type:*	jpg
	*Diagnosis:*	INTERTRIGO / CANDIDIASIS	*Category:*	papulosquamous eruptions / infections and infestations
	*Body Site:*	hand / finger	*Age:*	28 years
	*Contributor:*	Kosman Sadek Zikry, MD
	*Description:*	erythema, scaling, and maceration of the web spaces
	*Comments:*	This healthy kitchen worker had his hand in water constantly and developed a chronic intertrigo of the finger web spaces complicated intermittently by candidiasis.
	*Related Images:*	tinea_manus_intertrigo_1_040613

© 2001-2010, DermAtlas	*Image Name:*	tinea_manus_intertrigo_1_040613	*File Type:*	jpg
	*Diagnosis:*	INTERTRIGO / CANDIDIASIS	*Category:*	papulosquamous eruptions / infections and infestations
	*Body Site:*	hand / finger	*Age:*	28 years
	*Contributor:*	Kosman Sadek Zikry, MD
	*Description:*	erythema, scaling, and maceration of the web spaces
	*Comments:*	This healthy kitchen worker had his hand in water constantly and developed a chronic intertrigo of the finger web spaces complicated intermittently by candidiasis.
	*Related Images:*	tinea_manus_intertrigo_2_040613

© 2001-2010, DermAtlas	*Image Name:*	Candidiasis_1_040130	*File Type:*	jpg
	*Diagnosis:*	CANDIDIASIS / INTERTRIGO / DERMATITIS, DIAPER	*Category:*	papulosquamous eruptions / infections and infestations / environmental injury
	*Body Site:*	diaper area / genital thigh / scrotum	*Age:*	4 days
	*Contributor:*	Douglas Hoffman, MD
	*Description:*	moist intertriginous and scrotal erythema with red satellite papules
	*Comments:*	A potassium hydroxide preparation of scale from a satellite papule revealed abundant hyphae.

© 2001-2010, DermAtlas	*Image Name:*	Intertrigo_1_030403	*File Type:*	jpg
	*Diagnosis:*	INTERTRIGO	*Category:*	environmental injury
	*Body Site:*	trunk / abdomen breast	*Age:*	45 years
	*Contributor:*	Shahbaz A. Janjua, MD
	*Description:*	symmetric red scaly hyperpigmented patchesThis 45 years old woman had a 5 years history of developing erythematous maceration and crusting of her axillary,submammary and inguinal folds associated with itching,burning and stinging.Her condition was seasonal with summer exacerbations.She was advised to keep her folds dry and wear only cotton clothes during the summer months.She improved with topical Clotrimazole.
	*Comments:*	This 45-year-old woman developed recurrent red scaly itchy scaly macerated patches in the submammary, inguinal, abdominal and axillary creases particularly in the summer. The intertrigo improved when she wore light weight cotton clothing and applied clitrimazole cream.

© 2001-2010, DermAtlas	*Image Name:*	pseudomonas_1_020909	*File Type:*	jpg
	*Diagnosis:*	INTERTRIGO / GRAM NEGATIVE INFECTION / PSEUDOMONAS AERUGINOSA INFECTION / TOE WEB INFECTION	*Category:*	infections and infestations / vesiculobullous eruptions
	*Body Site:*	foot / toe toe web	*Age:*	49 years
	*Contributor:*	Vito Di Lernia, MD
	*Description:*	confluent edematous macerated crusted hemorrhagic yellowish brown patches
	*Comments:*	Over 15 days this 49 year old healthy man developed painful erosive macerated yellowish brown confluent patches in the toe web spaces of both feet. He was treated with oral and topical steroids and antifungal agents without improvement. After a bacterial culture grew Pseudomonas aeruginosa, he was switched to an oral third generation cephalosporin with gradual clearing over 2 weeks.