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Erosive toe-web intertrigo: Clinical features and management
N Jacob1, O Rousseau2, V Guardiolle3
1Dermatology Department, CHU de Nantes, Hôtel Dieu, 1 Place Alexis-Ricordeau, 44093 Nantes, France.
Background:
Toe-web (TW) intertrigo is a common disease of fungal or bacterial origin. Gram-negative bacterial (GNB) TW intertrigo consists of weeping, erosive, painful lesions that may be recurrent, leading to functional disability. Eczema is often associated with this condition. The management of intertrigo is poorly codified.
Objective:
To evaluate the efficacy and safety of a standardized treatment plan using topical steroids in relation to the course and the frequency of recurrence of GNB-TW intertrigo.
Methods:
We conducted a prospective open interventional multicentre study from June 2020 to June 2021. Standardised treatment using TCS together with follow-up via phone calls were performed over a 6-month period. In addition, a retrospective historical monocentric study was performed for patients with suspected TW-GNB intertrigo treated without standardized management. The primary endpoint was disease duration. We performed a Wilcoxon test to compare the median duration of GNB-TW intertrigo in both series.
Results:
We included 13 patients in the prospective cohort and 14 in the retrospective cohort. In both cohorts, most patients were male with a median age of 59 years. The most frequent signs were fissures and exudates. Eczema was often associated (51.8%). Identified risk factors were psoriasis, local humidity, fungal intertrigo, vascular disease (arterial or venous insufficiency), and a history of multiple local treatments prior to diagnosis. Pseudomonas aeruginosa was the predominant pathogen (48.1%). Median durations of TW-GNB intertrigo were 56 days and 61 days. There was no significant difference in the median duration of the disease between the prospective and the retrospective cohorts (respectively61 days and 56 days; p > 0.58). Relapses were more frequent in the retrospective cohort (respectively 7.7% and 21.4%).
Conclusion:
GNB-TW intertrigo is a difficult-to-treat disease often associated with eczema. While topical corticosteroids (TCS) seem to be an effective and well-tolerated treatment they do not appear to reduce disease duration compared to other treatments.
Insights
Gram-negative bacterial toe-web intertrigo (GNB-TW) is challenging to treat. Standardized topical corticosteroid (TCS) treatment showed efficacy but did not significantly reduce disease duration compared to non-standardized approaches.
Area of Science:
- Dermatology
- Infectious Diseases
- Pharmacology
Background:
- Gram-negative bacterial toe-web intertrigo (GNB-TW) presents as painful, weeping lesions, often recurrent and debilitating.
- Associated eczema and poorly codified management contribute to treatment challenges.
Purpose of the Study:
- To evaluate the efficacy and safety of a standardized treatment plan using topical corticosteroids (TCS).
- To assess the impact of standardized treatment on disease course and recurrence frequency in GNB-TW.
Main Methods:
- Prospective interventional study comparing standardized TCS treatment with a retrospective cohort using non-standardized management.
- Data collected on disease duration, recurrence, and associated factors over a 6-month period.
Main Results:
- No significant difference in median disease duration between standardized (61 days) and non-standardized (56 days) treatment groups.
- Relapses were more frequent in the non-standardized group (21.4%) compared to the standardized group (7.7%).
- Pseudomonas aeruginosa was the predominant pathogen (48.1%); eczema was associated in 51.8% of cases.
Conclusions:
- Topical corticosteroids (TCS) are effective and well-tolerated for GNB-TW intertrigo.
- Standardized treatment did not reduce disease duration but may decrease relapse frequency.
- GNB-TW intertrigo remains a difficult-to-treat condition, often linked with eczema.
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