Erythrasma

What is erythrasma?

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

Who Gets Erythrasma?

Erythrasma affects both men and women, but it is believed to be more common in the groin of men and between the fingers of women.

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

• Warm weather
• Excessive sweating
• Colored skin
• Diabetes
• Obesity
• Poor hygiene
• Advanced age
• Other immunocompromised state.

What Causes Erythrasma?

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

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

What are the clinical features of erythrasma?

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

Common sites for erythrasma are the armpits, groin, and between the toes. the intergluteal fold, submammary, and the periumbilical skin can also be affected. Extended Infections are most often associated with diabetes mellitus.

Erythrasma is classified into three types based on location.

1. Interdigital erythrasma: between the web spaces of the 3rd, 4th and 5th toes
2. Intertriginous erythrasma: in the armpits, groin, under the breasts and belly button
3. Generalized/ disciform erythrasma: on the trunk

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What are the complications of erythrasma?

Erythrasma is usually self-limited. It can be complicated by contact dermatitis, lichenification, post-inflammatory pigmentationand coinfection with other bacteria, yeasts, and dermatophytes.

Serious complications are very rare. Cornebacteria have been reported to cause abscesscellulitis cutaneous granuloma, endocarditis, pyelonephritis, endophthalmitis, arteriovenous fistula infection and meningitis.

How is the diagnosis of erythrasma made?

Erythrasma has a typical clinical appearance. The diagnosis can be supported by the following investigations.

• Wooden lamp skin examination: long wavelength Ultraviolet radiation causes the erythrasma to fluoresce a coral pink color due to coproporphyrin III released by the bacteria. The fluorescence is not seen if the skin has been washed recently because the responsible porphyrin is soluble in water
• Swab or skin scrapes: microscopy with periodic acid-Schiff, methanamine silver, or a gram stain can reveal gram-positive filamentary rods. Methylene blue also stains C. minutissimum.

What is the treatment for erythrasma?

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

• Fusidic acid cream

• Clindamycin solution

• Benzoyl peroxide
• Whitfield ointment (3% of salicylic acid, 6% of benzoic acid in petroleum jelly).

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

Photodynamic Red light therapy (broad band, peak at 635 nm) has also been used to treat patients with erythrasma.

Erythrasma prevention

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