S1 Guideline on Infected Interdigital Intertrigo (also called Gram-Negative Toe Web Infection)

Area of Science:

• Dermatology
• Infectious Diseases
• Podiatry

Background:

• Infected interdigital intertrigo involves mixed infections in toe webs, with gram-negative bacteria, gram-positive pathogens, and fungi.
• The term "infected interdigital intertrigo" is preferred over older terms like "gram-negative foot infection" for accuracy.

Purpose of the Study:

• To clarify the terminology, pathogens, clinical presentation, and management of infected interdigital intertrigo.
• To differentiate between superficial toe web infections and deeper soft tissue infections of the foot.

Main Methods:

• Clinical diagnosis based on characteristic signs and symptoms.
• Review of current understanding of causative agents and predisposing factors.
• Guidance on appropriate local and systemic treatment strategies.

Main Results:

• Common pathogens include Pseudomonas aeruginosa, Enterobacterales, Staphylococcus aureus, streptococci, enterococci, dermatophytes, and yeasts.
• Diabetes mellitus, polyneuropathy, and peripheral arterial disease are risk factors.
• Clinical diagnosis relies on painful macerated erosions/ulcers, exudate, odor, and edema; swabs are not always necessary.

Conclusions:

• Management emphasizes local anti-inflammatory, antiseptic, and antimycotic treatments, alongside dry wound care and edema reduction.
• Systemic antibiotics are indicated for associated soft-tissue infections, typically caused by Staphylococcus aureus in immunocompetent individuals.
• Vascular, imaging, and surgical assessments are crucial for deep infections or necrosis.