Risk factors and diverse management approaches for intertrigo: analysis of the “All of Us” research cohort

Intertrigo is an inflammatory dermatosis of skin folds whose risk factors and real-world management are incompletely defined. We analyzed electronic health records for 370,639 adults in the National Institutes of Health All of Us Research Program controlled tier version 8 and identified 5487 participants with at least one diagnostic code for intertrigo and a recorded body-mass index (BMI). Demographic, socioeconomic, and clinical covariates were compared with 365,152 controls using X2 tests and multivariable logistic regression. Treatment patterns were assessed at the visit level; encounters containing concurrent codes for common chronic inflammatory dermatoses or cutaneous infections were excluded to identify prescriptions intended for non-infected intertrigo. Higher BMI, older age, female or other sex, White race, non-Hispanic or Latino ethnicity, diabetes mellitus, incontinence, hyperhidrosis and vitamin D deficiency were all risk factors for intertrigo. A total of 14,173 visits for intertrigo were analyzed to identify treatment utilization. Topical antifungals were prescribed in 36% of visits, chiefly imidazoles (25%), and the most common combination was an imidazole plus a medium-potency corticosteroid (7.2%). Oral or topical antibiotics appeared in 15% of visits, usually as adjunctive rather than sole therapies, and skin protectants were rarely prescribed. These findings expand the spectrum of risk factors to include hyperhidrosis and vitamin D deficiency and reveal heterogeneity in real-world treatment, identifying a potential need for evidence-based intertrigo management guidelines.