We are all familiar with the issues that surround the febrile infant and the appropriate work-up. Often our familiarity can lead to complacency. One area that we need to remain vigilant is in performing a thorough physical exam. On occasion, the answer that we are looking for is right on the surface.
- Intertrigo is a superficial cellulitis that localizes to intertriginous folds; folds, which are common in young infants (as well as patients of any age with generous sub-Q tissue).
- Because of large heads and decreased muscle tone, infants have deep neck folds.
- Those “well-feed” infants may have redundant folds in the axillae, groin, and leg regions.
- Opposing sides of these folds become macerated because of fiction and become a portal of entry for skin flora.
- Group A Beta-Hemolytic Strep may cause Intertrigo and the child may present with fussiness and low-grade fevers.
- Many times this area has already been treated with a variety of topical ointments and creams (including anti-fungals).
- The deep area of the fold will have a beefy-red, denuded appearance without satellite lesions.
- Treated with 10-day course of oral penicillin or 1st Gen. Cephalosporin.
- A neonate, however, deserves more conservative management.Honig, PJ. The great masqueraders: skin disorders that fool the eye. Contemp Pediatr. 1991; 8:98-109