Erythrasma

Erythrasma (Greek, "red spot") is a chronic bacterial infection caused by Corynebacterium minutissimum affecting the intertriginous areas of the webspace of the feet, groins, axillae, and submammary areas, which mimics epidermal dermatophyte infections. The organism rarely causes invasive infections. Epidemiology and Etiology Age of Onset Adults Etiology C. minutissimum, gram-positive (diphtheroid), non-spore-forming, aerobic or facultatively anaerobic bacillus; part of normal skin flora, which causes superficial infection under certain conditions. Predisposing Factors Humid cutaneous microclimate: warm and/or humid climate or season; occlusive clothing/shoes; obesity, hyperhidrosis. History Symptoms Usually asymptomatic. Duration: weeks to months to years. Physical Examination Skin Lesions Macule, sharply marginated (Fig. 22-1). Scaling at sites not continuously occluded. In webspaces of feet, may be macerated (Fig. 22-2), eroded, or fissured. Often symmetric or in multiple webspaces. Red or brownish red; postinflammatory hyperpigmentation in more heavily melanized individuals. If pruritic, secondary changes of excoriation, lichenification. Dermatophytosis and/or candidiasis may also be present. Sites of Predilection Toe webspaces (Fig. 22-2) >> groin folds (Fig. 22-1) > axillae; also, intertriginous skin under panniculus, intergluteal, inframammary. Differential Diagnosis Well-Demarcated Intertriginous Plaque

Dermatophytosis, intertriginous candidiasis, pityriasis versicolor, pitted keratolysis, inversepattern psoriasis, seborrheic dermatitis, acanthosis nigricans. Laboratory Examinations Wood's Lamp The diagnosis is made by demonstration of the characteristic coral-red fluorescence (attributed to coproporphyrin III). May not be present if patient has bathed recently. Direct Microscopy Negative for fungal forms on KOH preparation of skin scraping. In the webspaces of the feet, concomitant interdigital tinea pedis may also be present. Gram or Giemsa stains may show fine bacterial filaments. Bacterial Culture Heavy growth of Corynebacterium. Rules out Staphylococcus aureus, group A streptococcus, and Candida infection. In some cases, concomitant Pseudomonas aeruginosa webspace infection (feet) is also present. Diagnosis Clinical findings, absence of fungi on direct microscopy, positive Wood's lamp examination. Course Relapse occurs if predisposing causes are not corrected. Secondary prophylaxis usually indicated. Management Prevention/Prophylaxis Wash with benzoyl peroxide (bar or wash). Medicated powders (do not use cornstarch powder). Topical antiseptic alcohol gels: isopropyl, ethanol. Topical Therapy Preferable. Benzoyl peroxide (2.5%) gel daily after showering for 7 days. Topical erythromycin or clindamycin solution bid for 7 days. Sodium fusidate ointment, mupirocin ointment or cream. Topical antifungal agents: clotrimazole, miconazole, or econazole. Systemic Antibiotic Therapy Erythromycin or tetracycline, 250 mg qid for 14 days. Clarithromycin. Sinopsis fitspatrick