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Erythrasma

Author: Reviewed and updated by Dr Amanda Oakley Dermatologist, Hamilton, New Zealand; Vanessa Ngan, Staff Writer, June 2014; Dr Jannet Gomez, Postgraduate Student in Clinical Dermatology, Queen Mary University London, United Kingdom, July 2016.


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What is erythrasma?

Erythrasma is a common skin condition affecting the skin folds under the arms, in the groin and between the toes.

Who gets erythrasma?

Erythrasma affects males and females, but it is thought to be more common in the groin of males and between the toes of females.

It is reported to be more prevalent in the following circumstances: 

  • Warm climate
  • Excessive sweating
  • Skin of colour
  • Diabetes
  • Obesity
  • Poor hygiene
  • Advanced age
  • Other immunocompromised states.

What causes erythrasma?

The bacteria responsible for erythrasma are gram-positive, non-spore-forming, aerobic or facultative bacilli called Corynebacterium minutissimum

Erythrasma may coexist with or be confused with other causes of intertrigo including fungal infections such as tinea or Candida albicans (thrush). 

What are the clinical features of erythrasma?

Erythrasma presents as well-defined pink or brown patches with fine scaling and superficial fissures. Mild itching may be present.

The common sites for erythrasma are armpits, groin and between the toes. The intergluteal fold, submammary, and periumbilical skin may also be affected. Widespread infections are most often associated with diabetes mellitus.

Erythrasma is classified into three types according to location.

  1. Interdigital erythrasma: between the 3rd, 4th and 5th toe web spaces
  2. Intertriginous erythrasma: in the armpits, groin, under the breasts and umbilicus
  3. Generalised/disciform erythrasma: on the trunk 

Erythrasma

See more images of erythrasma.

What are the complications of erythrasma?

Erythrasma is usually self-limiting. It can be complicated by contact dermatitis, lichenification, postinflammatory pigmentation, and coinfection with other bacteria, yeasts, and dermatophytes.

Serious complications are very rare. Corynebacteria have been reported to causes abscess, cellulitis, cutaneous granuloma, endocarditis, pyelonephritis, endophthalmitis, arteriovenous fistula infection and meningitis.

How is the diagnosis of erythrasma made?

Erythrasma has a typical clinical appearance. Diagnosis may be supported by the following investigations.

  • Wood lamp skin examination: long wavelength ultraviolet radiation causes erythrasma to fluoresce a coral-pink colour due to coproporphyrin III released by the bacteria. The fluorescence is not seen if the skin has recently been washed because the responsible porphyrin is water soluble.
  • Swab or skin scrapings: microscopy with periodic acid–Schiff, methenamine silver, or a Gram stain may reveal gram-positive filamentous rods. Methylene blue also stains C. minutissimum

What is the treatment for erythrasma?

Erythrasma can be treated with antiseptic or topical antibiotic such as:

Extensive infection can be treated with oral antibiotics, including erythromycin or tetracycline and usually responds promptly. 

Photodynamic therapy using red light (broadband, peaking at 635 nm) has also been used to treat patients with erythrasma.

How is erythrasma prevented?

Recurrence of erythrasma is common. Antibacterial soap can be used to prevent recurrence. Treatment can be repeated if necessary.

 

References

  • Bolognia, Jean L., et al. Dermatology Essentials E-Book. Elsevier Health Sciences, 2014.pg 581–582.
  • SARKANY I, TAPLIN D, BLANK H. The etiology and treatment of erythrasma. J Invest Dermatol. 1961 Oct;37:283–90. PubMed PMID: 14497222. PubMed.
  • Morales-Trujillo ML, Arenas R, Arroyo S. [Interdigital erythrasma: clinical, epidemiologic, and microbiologic findings]. Actas Dermosifiliogr. 2008 Jul-Aug;99(6):469–73. Spanish. PubMed PMID: 18558055. PubMed.
  • Chodkiewicz HM, Cohen PR. Erythrasma: successful treatment after single-dose clarithromycin. Int J Dermatol 2013; 52:516.
  • Avci O, Tanyildizi T, Kusku E. A comparison between the effectiveness of erythromycin, single-dose clarithromycin and topical fusidic acid in the treatment of erythrasma. Journal of Dermatological Treatment. 2013 Feb 1;24(1):70–4. PubMed.
  • Santos-Juanes J, Galache C, Martinez-Cordero A, et al. Cutaneous granulomas caused by corynebacterium minutissimum in an HIV-infected man. J Eur Acad Dermatol Venereol . 2002 Nov. 16(6):643–5.PubMed.
  • Dalal A, Likhi R. Corynebacterium minutissimum bacteremia and meningitis: a case report and review of literature. J Infect. 2008 Jan. 56(1):77–9. PubMed.

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