Severe Gram-Negative Intertrigo of the Feet

Introduction: Intertrigo is a common disease of the skin usually caused by fungi and/or bacteria, often involving major or minor skin folds. Here, we report a case of severe, ulcerative intertrigo of all interdigital folds of both feet caused by Pseudomonas aeruginosa in a patient with type II diabetes who acquired the infection during a trip to Senegal.
Case Presentation: Lesions involved all toe-web spaces and the back of the toes and the soles. Ulcers with a purulent-necrotic bed, with some of them covered by brownish-black eschars associated with a greenish, odiferous discharge were recorded. The patient was treated with piperacillin/tazobactam IM for 14 days, achieving complete remission of the infection. In this article, we underline the importance of an early diagnosis and appropriate treatment to achieve healing of bacterial intertrigo without complications. Topical therapy with antiseptics (potassium permanganate, gentian violet solution, hydrogen peroxide) or antibiotics (gentamicin, amikacin) is effective only in early stages of the infection. Systemic antibiotics must be considered in all extensive and severe cases. The choice of antibiotic should be based on the culture and antibiogram results. When this is not possible, wide-spectrum antibiotics that act on both gram-positive and gram-negative bacteria (such as third-generation cephalosporin or quinolone) should be prescribed.
Conclusion: The length of treatment should not be less than ten days. In addiction, all patients should be trained to avoid predisposing conditions and adopt preventive measures to reduce the risk of infection.