| Summary: | Gram-negative infection of the toe web space is less frequent than dermatophytes and yeasts, but it is
more challenging, especially with the involvement of Pseudomonas aeruginosa in relation to antibiotic
resistance and the increased risk of potentially lethal complications. Many conditions, other than infections,
might initially present with the same clinical features, recognising the common initial damage (intertrigo),
due to skin-on-skin rubbing in a moist environment with air entrapment, which is typical of interdigital
spaces. Conditions such as contact eczema, atopic dermatitis, and inverse psoriasis, frequently predispose
to, and are maintained by, the intertrigo, triggering a vicious circle. The dermatologist is in a lead position to
address the correct assessment and management. A careful screening for predisposing factors is necessary:
overweight, diabetic, but also athletes or people attending swimming pools, gyms, public showers/dressing
rooms, and thermal baths are also at an increased risk of intertrigo of the toe web spaces. Occupational
activities other than recreational might be relevant, such as the use of safety shoes or working in wet warm
conditions. Incongruous therapy for tinea pedis or contact dermatitis, frequently auto-prescribed, might be
among promoting factors altering the microbial ecosystem balance. The aim of this review is to evaluate
the main epidemiologic and clinical features of Gram-negative bacteria intertrigo, the role of promoting
factors, and the measures taken to treat and prevent this disorder. Appropriate treatment and patient
education are crucial to prevent further infection and relapses.
|
|---|
