Risk Factors for Chronic Intertrigo of the Lymphedema Leg in Southern India: A Case-Control Study

Rich clinical experiences indicate that toe web intertrigo is a major predisposing condition for cellulitis/acute dermatolymphango adenitis (ADLA) and the number of lesions is the strongest predictor of frequency of ADLA in lymphedema (LE) patients. However, there is scanty information on the risk factors for the establishment of chronic toe web intertrigo in LE patients. We performed a case-control study recruiting 52 lower limb LE with intertrigo and 52 lower limb LE without intertrigo in community settings and assessed general and local potential risk factors for chronic intertrigo. Analysis of local risk factors revealed that topical application of oil, tingling and numbness of the extremities were associated independently with chronic intertrigo. In multivariate analysis, LE grades III and IV were associated with chronic intertrigo, after adjusting for tingling and numbness, prophylactic antibiotic, age group, and gender. From a public health perspective, LE patients of grades III and IV and patients under antibiotic prophylaxis should be self-motivated to look for the early symptoms of toe web intertrigo to prevent chronic stage and recurrent episodes of cellulitis. Patients with history of tingling and numbness of the periphery need to be monitored for pressure effects leading to poor vascularization and delayed healing of intertrigo.