- 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 — General Dermatology
- Professor of Dermatology and Public Health
- University of Colorado School of Medicine
- Colorado School of Public Health
- Chief, Dermatology Service
- US Department of Veterans Affairs
- Eastern Colorado Health Care System
- 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 stain-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 stain-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.
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- Cochran RJ, Rosen T, Landers T. Topical treatment for erythrasma. Int J Dermatol 1981; 20:562.
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- 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.
- 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.
- Greywal T, Cohen PR. Erythrasma: A report of nine men successfully managed with mupirocin 2% ointment monotherapy. Dermatol Online J 2017; 23.
- 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.
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- 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
- INDICATIONS FOR REFERRAL
- SUMMARY AND RECOMMENDATIONS