Rashes in the natal cleft can be intertrigo, tinea or
psoriasis. We usually think of psoriasis as being a red scaly disease but when
it involves the flexures with occluded surfaces ,the scale is lost, except at
the outer edges. Tinea is rarely as symmetrical as this while intertrigo with
sweating can look very similar but there will not be any edge scales. Sometimes
psoriasis and intertrigo can be complicated by secondary candida infection.
These will present as satellite pustules, small pustules beyond the edge of the
rash. Simple intertrigo requires cotton between the occluding skin surfaces and
reduced sweating. Flexural psoriasis responds best to a mixture of 1%
hydrocortisone cream and clotrimazole cream applied twice daily. Stronger
topical steroid creams should be avoided as they may cause skin thinning and
striae because of increased absorption because of the occlusion. A similar
clinical picture can be seen with psoriasis under the breasts and in the
axillae. See www.skinconsult.com.au
for further discussion.
