- Sylvia Brice, MD
Sylvia Brice, MD
- Associate Professor of Dermatology
- University of Colorado Denver, School of Medicine
- Section Editors
- Robert P Dellavalle, MD, PhD, MSPH
Robert P Dellavalle, MD, PhD, MSPH
- Section Editor — Dermatology
- 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).
The epidemiology, clinical manifestations, diagnosis, and treatment of erythrasma will be discussed here.
EPIDEMIOLOGY AND RISK FACTORS
Erythrasma is a common disorder. However, the prevalence is difficult to assess since many patients do not seek treatment or have subclinical infection. In a 1970 study of 754 college students in the UK, 19 percent had erythrasma . A subsequent study of patients seen in a New Zealand dermatology clinic found a prevalence of 20 percent . Higher prevalences have been reported in soldiers and institutionalized patients [3,4].
Erythrasma often occurs in healthy adults , but diabetic patients, older adults, or immunocompromised patients have increased risk for the disorder . Conditions predisposing to skin occlusion and moisture also contribute to erythrasma, including obesity, hyperhidrosis, and living in tropical climates. Erythrasma is rare in children .
Erythrasma is caused by C. minutissimum, a component of the normal skin flora. C. minutissimum is a gram-positive, non-spore-forming, aerobic or facultative bacillus . Under conditions of moisture and occlusion, C. minutissimum proliferates in the upper levels of the stratum corneum.
- Somerville DA. Erythrasma in normal young adults. J Med Microbiol 1970; 3:57.
- Allen S, Christmas TI, McKinney W, et al. The Auckland skin clinic tinea pedis and erythrasma study. N Z Med J 1990; 103:391.
- Somerville DA, Seville RH, Cunningham RC, et al. Erythrasma in a hospital for the mentally subnormal. Br J Dermatol 1970; 82:355.
- 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.
- Holdiness MR. Management of cutaneous erythrasma. Drugs 2002; 62:1131.
- Blaise G, Nikkels AF, Hermanns-Lê T, et al. Corynebacterium-associated skin infections. Int J Dermatol 2008; 47:884.
- Penton PK, Tyagi E, Humrighouse BW, McQuiston JR. Complete Genome Sequence of Corynebacterium minutissimum, an Opportunistic Pathogen and the Causative Agent of Erythrasma. Genome Announc 2015; 3.
- 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.
- 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.
- 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.
- 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.
- Mirsky L, Watters K, Jafarian F. Chronic hyperpigmented scaly plaques. Pityriasis rotunda (PR). Arch Dermatol 2012; 148:1073.
- Cochran RJ, Rosen T, Landers T. Topical treatment for erythrasma. Int J Dermatol 1981; 20:562.
- 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.
- 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.
- Ramelet AA, Walker-Nasir E. One daily application of oxiconazole cream is sufficient for treating dermatomycoses. Dermatologica 1987; 175:293.
- 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.
- 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.
- 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.
- Halpern AV, Heymann WR. Bacterial diseases. In: Dermatology, 2nd ed, Bolognia JL, Jorizzo JL, Rapini RP, et al (Eds), Elsevier, St. Louis 2008. p.1075.
- EPIDEMIOLOGY AND RISK FACTORS
- CLINICAL PRESENTATION
- Physical examination
- Gram stain
- KOH preparation
- Other tests
- DIFFERENTIAL DIAGNOSIS
- Localized erythrasma
- - Topical clindamycin or erythromycin
- - Topical fusidic acid
- - Topical imidazole antifungal agents
- - Other topical therapies
- Extensive erythrasma
- - Clarithromycin or oral erythromycin
- Other therapies
- SUMMARY AND RECOMMENDATIONS