- Sylvia Brice, MD
Sylvia Brice, MD
- Associate Professor of Dermatology
- University of Colorado Denver, School of Medicine
- Mariah Brown, MD
Mariah Brown, MD
- Assistant Professor
- University of Colorado Denver, School of Medicine
- Section Editors
- Robert P Dellavalle, MD, PhD, MSPH
Robert P Dellavalle, MD, PhD, MSPH
- Section Editor — Dermatology
- Associate Professor of Dermatology and Public Health
- Denver VA Medical Center, University of Colorado School of Medicine and Colorado School of Public Health
- Ted Rosen, MD
Ted Rosen, MD
- Section Editor — Infections and Infestations
- Professor, Department of Dermatology
- Baylor College of Medicine
Erythrasma is a superficial infection of the skin caused by Corynebacterium minutissimum, a gram-positive, non-spore forming bacillus (picture 1). The disorder typically presents as macerated, scaly plaques between the toes or erythematous to brown patches or thin plaques in intertriginous areas (picture 2A-G). Erythrasma is managed with short courses of either topical or systemic therapy.
The epidemiology, clinical manifestations, diagnosis, and treatment of erythrasma, as well as a brief overview of other C. minutissimum infections will be discussed here.
EPIDEMIOLOGY AND RISK FACTORS
Erythrasma is a common disorder. However, the prevalence of erythrasma is difficult to assess, as many patients do not seek treatment or have subclinical infection. In one study of 754 college students in the UK published in 1970, 19 percent were infected with erythrasma . Another study of 874 patients in an institutional setting in the UK, also published in 1970, found a prevalence rate as high as 43 percent .
The prevalence of interdigital erythrasma in other cohorts ranges from 20 percent in patients attending a dermatology clinic to greater than 50 percent in soldiers [3,4]. Interdigital erythrasma frequently goes unrecognized in clinical practice; a 2010 Turkish study of 122 patients with clinical findings suggestive of interdigital tinea pedis found that 47 percent had erythrasma, including many who had both tinea pedis and erythrasma .
Erythrasma often occurs in healthy adults , but diabetic, older adult, or immunocompromised patients have increased risk for the disorder . The infection can be a presenting sign of type 2 diabetes, occurring before persistent glucose abnormalities . Conditions that lead to increased occlusion and moisture of intertriginous areas are also believed to contribute to erythrasma, including obesity, hyperhidrosis, and living in tropical climates. Erythrasma is rare in children [8,9].
- Somerville DA. Erythrasma in normal young adults. J Med Microbiol 1970; 3:57.
- Somerville DA, Seville RH, Cunningham RC, et al. Erythrasma in a hospital for the mentally subnormal. Br J Dermatol 1970; 82:355.
- Allen S, Christmas TI, McKinney W, et al. The Auckland skin clinic tinea pedis and erythrasma study. N Z Med J 1990; 103:391.
- Svejgaard E, Christophersen J, Jelsdorf HM. Tinea pedis and erythrasma in Danish recruits. Clinical signs, prevalence, incidence, and correlation to atopy. J Am Acad Dermatol 1986; 14:993.
- Inci M, Serarslan G, Ozer B, et al. The prevalence of interdigital erythrasma in southern region of Turkey. J Eur Acad Dermatol Venereol 2012; 26:1372.
- Holdiness MR. Management of cutaneous erythrasma. Drugs 2002; 62:1131.
- Montes LF, Dobson H, Dodge BG, Knowles WR. Erythrasma and diabetes mellitus. Arch Dermatol 1969; 99:674.
- Blaise G, Nikkels AF, Hermanns-Lê T, et al. Corynebacterium-associated skin infections. Int J Dermatol 2008; 47:884.
- SARKANY I, TAPLIN D, BLANK H. The etiology and treatment of erythrasma. J Invest Dermatol 1961; 37:283.
- Golledge CL, Phillips G. Corynebacterium minutissimum infection. J Infect 1991; 23:73.
- Dellion S, Morel P, Vignon-Pennamen D, Felten A. Erythrasma owing to an unusual pathogen. Arch Dermatol 1996; 132:716.
- Morales-Trujillo ML, Arenas R, Arroyo S. [Interdigital erythrasma: clinical, epidemiologic, and microbiologic findings]. Actas Dermosifiliogr 2008; 99:469.
- Tschen JA, Ramsdell WM. Disciform erythrasma. Cutis 1983; 31:541.
- Engber PB, Mandel EH. Generalized disciform erythrasma. Int J Dermatol 1979; 18:633.
- Bowyer A, McColl I. Erythrasma and pruritus ani. Acta Derm Venereol 1971; 51:444.
- Bowyer A, McColl I. The role of erythrasma in pruritus ani. Lancet 1966; 2:572.
- Mattox TF, Rutgers J, Yoshimori RN, Bhatia NN. Nonfluorescent erythrasma of the vulva. Obstet Gynecol 1993; 81:862.
- Wilson BB, Wagenseller A, Noland MM. An atypical presentation of erythrasma. J Am Acad Dermatol 2012; 67:e217.
- Sariguzel FM, Koc AN, Yagmur G, Berk E. Interdigital foot infections: Corynebacterium minutissimum and agents of superficial mycoses. Braz J Microbiol 2014; 45:781.
- Sindhuphak W, MacDonald E, Smith EB. Erythrasma. Overlooked or misdiagnosed? Int J Dermatol 1985; 24:95.
- Grimalt R, Gelmetti C, Brusasco A, et al. Pityriasis rotunda: report of a familial occurrence and review of the literature. J Am Acad Dermatol 1994; 31:866.
- Somerville DA, Noble WC, White PM, et al. Sodium fusidate in the treatment of erythrasma. Br J Dermatol 1971; 85:450.
- Hamann K, Thorn P. Systemic or local treatment of erythrasma? A comparison between erythromycin tablets and Fucidin cream in general practice. Scand J Prim Health Care 1991; 9:35.
- Macmillan AL, Sarkany I. Specific topical therapy for erythrasma. Br J Dermatol 1970; 82:507.
- 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. J Dermatolog Treat 2013; 24:70.
- Cochran RJ, Rosen T, Landers T. Topical treatment for erythrasma. Int J Dermatol 1981; 20:562.
- Badri T, Sliti N, Benmously R, et al. [Erythrasma: study of 16 cases]. Tunis Med 2014; 92:245.
- Ramelet AA, Walker-Nasir E. One daily application of oxiconazole cream is sufficient for treating dermatomycoses. Dermatologica 1987; 175:293.
- Pitcher DG, Noble WC, Seville RH. Treatment of erythrasma with miconazole. Clin Exp Dermatol 1979; 4:453.
- Grigoriu D, Grigoriu A. Double-blind comparison of the efficacy, toleration and safety of tioconazole base 1% and econazole nitrate 1% creams in the treatment of patients with fungal infections of the skin or erythrasma. Dermatologica 1983; 166 Suppl 1:8.
- Clayton YM, Hay RJ, McGibbon DH, Pye RJ. Double blind comparison of the efficacy of tioconazole and miconazole for the treatment of fungal infection of the skin or erythrasma. Clin Exp Dermatol 1982; 7:543.
- Seville RH, Somerville DA. The treatment of erythrasma in a hospital for the mentally subnormal. Br J Dermatol 1970; 82:502.
- Craft N, Lee PK, Zipoi MT, et al. Superficial cutaneous infections and pyodermas. In: Fitzpatrick's Dermatology in General Medicine, 7th ed, Wolff K, Goldsmith LA, Katz SI, et al (Eds), McGraw Hill, 2008. p.1694.
- Dodge BG, Knowles WR, McBride ME, et al. Treatment of erythrasma with an antibacterial soap. Arch Dermatol 1968; 97:548.
- Kooistra JA. Prophylaxis and control of erythrasma of the toe webs. J Invest Dermatol 1965; 45:399.
- Taber D, Yackovich F. Use of an antibacterial soap in the treatment of erythrasma of the toe webs. Cutis 1969; 5:991.
- Wharton JR, Wilson PL, Kincannon JM. Erythrasma treated with single-dose clarithromycin. Arch Dermatol 1998; 134:671.
- Chodkiewicz HM, Cohen PR. Erythrasma: successful treatment after single-dose clarithromycin. Int J Dermatol 2013; 52:516.
- Shelley WB, Shelley ED. Coexistent erythrasma, trichomycosis axillaris, and pitted keratolysis: an overlooked corynebacterial triad? J Am Acad Dermatol 1982; 7:752.
- Turk BG, Turkmen M, Aytimur D. Antibiotic susceptibility of Corynebacterium minutissimum isolated from lesions of Turkish patients with erythrasma. J Am Acad Dermatol 2011; 65:1230.
- Darras-Vercambre S, Carpentier O, Vincent P, et al. Photodynamic action of red light for treatment of erythrasma: preliminary results. Photodermatol Photoimmunol Photomed 2006; 22:153.
- Rho NK, Kim BJ. A corynebacterial triad: Prevalence of erythrasma and trichomycosis axillaris in soldiers with pitted keratolysis. J Am Acad Dermatol 2008; 58:S57.
- Halpern AV, Heymann WR. Bacterial diseases. In: Dermatology, 2nd ed, Bolognia JL, Jorizzo JL, Rapini RP, et al (Eds), Elsevier, 2008. p.1075.
- EPIDEMIOLOGY AND RISK FACTORS
- CLINICAL PRESENTATION
- Physical examination
- Gram stain
- KOH preparation
- Other tests
- DIFFERENTIAL DIAGNOSIS
- Localized erythrasma
- - Topical fusidic acid
- - Topical clindamycin or erythromycin
- - Topical imidazole antifungal agents
- - Other topical therapies
- Extensive erythrasma
- - Oral clarithromycin or erythromycin
- Other therapies
- OTHER CUTANEOUS CORYNEBACTERIUM INFECTIONS
- SUMMARY AND RECOMMENDATIONS