Extensive Intertrigo and Irritant Contact Dermatitis of Groins in Pregnant Female Due to Overuse of Feminine Hygiene Products

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Intertrigo or intertriginous dermatitis is a common skin condition that occurs when skin folds in regions prone to friction, such as the armpits, groin, under the breasts, and between the buttocks, etc., become inflamed. Obesity heightens the risk due to amplified friction and moisture in these skin folds. Intimate wash products containing harsh chemicals, fragrances, and preservatives can cause irritation of the skin and contribute to the development of intertrigo.

Here, we report a case of extensive intertrigo with irritant contact dermatitis in an obese female after prolonged use of female intimate hygiene wash products. A 30-year-old obese female, weighing 110 kg, in the third month of her pregnancy, came with complaints of raw, reddish skin of groin folds and vulva associated with intense burning and itching for two weeks. A week ago, she had sought help from a local practitioner who failed to identify the cause and prescribed a topical steroid cream for relief. However, the patient only experienced slight improvement and decided to see a specialist due to persistent symptoms. Observing the inflamed appearance of the lesions, we strongly suspected contact dermatitis to some personal use item and thus inquired the patient about her habits and use of various products in the affected area. It was revealed that she had been using a particular intimate hygiene wash excessively, about three to four times daily for a month, leading to the development of the lesions within 10 days of its use.

On examination, there was extensive inflammation with considerable maceration of the skin of the vulva, mons pubis, and bilateral groins, with few erosions over an intensely erythematous base associated with a foul odor [Figures 1a and b]. Based on this history and clinical examination, a diagnosis of intertrigo with added irritant contact dermatitis was made, and appropriate treatment was commenced.

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Figure 1:

(a) Clinical examination of vulva and groins at the time of presentation. Extensive inflammation with maceration of the skin of the vulva, mons pubis, and bilateral groins. (b) Erosions in groins at the time of presentation. Multiple erosions over intensely erythematous base noted in bilateral groins. (c) Clinical examination of vulva and groins after one week of treatment. Near total resolution of lesions after seven days of treatment.

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The patient was advised to discontinue the use of the intimate washes immediately and start once daily application of sodium fusidate 2% cream, dusting of clotrimazole powder in skin folds after bathing, and nightly application of clotrimazole 1% cream. Once a week, low-dose (200 mg) oral fluconazole was prescribed keeping in mind the gestational age of the patient. This regime resulted in near total resolution of the lesions in a mere seven days, confirming the diagnosis [Figure 1c]. This rapid response was attributed partially to treatment and partially to discontinuing the triggering agent.

Intertrigo is a prevalent inflammatory skin condition resulting from friction between adjacent skin surfaces in intertriginous regions. Obesity increases the likelihood of developing intertrigo. Obese individuals have a larger body fold surface area, providing a larger space for friction. They also tend to perspire more within these body folds resulting in increased moisture retention. Also, the skin of those with a BMI exceeding 25 is discovered to be more alkaline, increasing the susceptibility to superinfections.^[1,2]

Due to the increasing popularity of feminine hygiene products, more women have started incorporating a variety of intimate hygiene products into their daily cleansing rituals. Numerous products are available for cleanliness and odor control, but they need to be used with caution as some may disrupt the essential pH level and microbiota of the vulvovaginal region, crucial for safeguarding against infections.^[3,4] The key ingredients in the product being used by our patient were lactic acid, triethanolamine lauryl sulfate, ammonium lauryl sulfate, cocamidopropyl betaine, phenoxyethanol, benzoic Acid, polyquaternium-7, and fragrance.

Constituents of female intimate washes and wipes that are commonly implicated in the development of irritant contact dermatitis include fragrances, preservatives like parabens, and surfactants like sodium lauryl sulfate, which strip the skin of its natural oils and cause irritation. Their overuse may cause irritation and thus contribute to the development of intertrigo as well as contact dermatitis as was seen in our case.^[5]

Thus, it is essential to choose intimate washes that are specifically formulated for sensitive skin and maintain a pH balance suitable for the vaginal area. In addition, using these products sparingly and avoiding overuse can help prevent irritation.