INTERTRIGO.
Definition.—Intertrigo is an hyper aemic affection of the skin characterized by an erythematous condition produced upon contiguous surfaces, accompanied with an exudation of sweat with macera tion of the skin.
Symptoms.—Intertrigo is produced through closeness of contact between two opposing surfaces The juxtaposi tion may cause irritation whether as sisted or not by friction. It is an affec tion of hot weather, but may also occur in the winter. Heat acting directly on the subject and thus indirectly upon con tiguous areas assists in its production and extension. It occurs in regions such as the nates, groins, axillae, the spaces be tween and beneath the breasts in the female or in corpulent male,s, as well as overlapping portions of the abdomen, the sulci of the fingers and toes and, in fact, any redundant portion of skin.
At first there is only an erythematous blush, but this soon increases in degree and in extent. Prolonged contiguity may lead to a true traumatic erythema, which with the retained sweat causes macera tion of the adjacent portions of skin. If allowed to continue, the maceration may extend and end in a true inflammatory process. In infants intertrigo is apt to be an annoying affection, especially when it occurs through inattention of the parts after micturition and defeca tion. Eczema is likely to supervene if no attention be given. The rubbing is also encountered after horseback-riding, rubbing of tight-fitting boots or clothes, etc. (erythema paratrimma).
The parts are hot and tender, if not actually painful, and movement causes a scraping sensation. In an unattended case bleeding may occur as a result of fis sures and removal of the upper layers of the epidermis. The parts emit a dis agreeable odor, and according to Crocker. of London, stain—but do not stiffen— linen: a point which this author adduces as of diagnostic value between eczema and intertrigo.
Diagnosis.—The diagnosis of this con dition is not difficult. The fact that there are two opposing surfaces in which there is a retention of sweat, emitting a disagreeable odor, and causing macera tion and fissuring of these surfaces, should be sufficient in most cases. Re
moval of the cause is generally followed by an early cessation of the symptoms. Eczema will persist for shorter or longer periods, according to the extent of sur face involved, and not alone will remain in position, but will also increase, if not judiciously treated. In the latter affec tion there is some degree of infiltration and thickening, which does not occur in erythema intertrigo unless eczema com plicates the process. Congenital syphilis may also be confounded with this affec tion, but the fact that syphilis extends far beyond the borders of the contiguous surfaces will generally suffice to prevent error. Syphilis also produces a darker discoloration. An "erytUnie syphilidi forme" is noted by A. Fournier, which begins as a papulo-vesicle and resembles the vaccine-papule; but, as these lesions are to be found in repeated succession, error is hardly possible.
Etiology.—The causes of intertrigo are manifold. Warm weather or heat produced by artificial means during the winter season may act as an inducing factor. Exaggerated exercise, rowing, running, horseback-riding, as well as sedentary habits as observed in clerks who it for long periods on leather-cush ioned stools, or persons who wear un suitable undergarments, and sweating at contiguous points are known causes. Friction, with or without moisture, will induce it. Secretions—such as saliva (the cases, for instance, following re peated protrusion of the tongue and lick ing the parts), vaginal discharges, un removed faeces during the existence of a diarrhoea, the dribbling of urine and the complication of glycosuria—are as many etiological factors. Many other condi tions contribute to assist in its produc tion and extension, such as the milk upon the garments of careless mothers, which, thus being allowed to dry, rough ens and stiffens the dressings; so that rubbing is soon induced. In young infants improperly-washed diapers are also causative media.