CASE REPORT

Erythrasma

By: Dianne Kartika Putri

Supervisor: Irma Tarida L, dr. Sp.KK

DERMATOLOGY AND VENEREOLOGY DEPARTEMENT

MARDI WALUYO GENERAL HOSPITAL BLITAR
MEDICAL FACULTY ISLAMIC UNIVERSITY OF MALANG
2018
 IDENTITY

• Name : Mr. S
• Age : 64 years old
• Sex : Male
• Address : Ponggok - Blitar
• Job : Farmer
• Religion : Islam
• Marriage status : Married
• Examination date : March 26th 2018
 HISTORY

• Main complain:
– Brown spots on the right and left armpits
• History of the disease:
Patients come with brown spots on the right and
left armpits since yesterday. He didn’t know when it
first appears. He knew when he is lifting both hands,
then his wife told him there is a brown spot on both
armpits. He didn’t complain of itching, but he often
sweats.
 HISTORY

• Medical history:
– Patients had never been treated
• Family history:
– No family history
 HISTORY

• Past medical history:

– No past medical history of dermatology disease
– No Diabetes Mellitus history
• Allergy history:
– No allergy history drugs or food
 PHYSICAL EXAMINATION

• General condition:
– Good condition
• Consciousness:
– Compos mentis, GCS 4 5 6
• Vital sign:
– Pulse : 84x/minute
– RR : 20x/minute
– Tax : not performed
 DERMATOLOGICAL STATUS

• Regio:
– Axillaris dextra
et sinistra
• Efflorescence
– Sharply
demarcated
hyperpigmented
macule
 DIAGNOSIS

• Diagnosis:
– Erythrasma
• Differential diagnosis:
– Intertrigo Candidiasis
– Seborrheic dermatitis
– Pityriasis versicolor
 PLANNING DIAGNOSTIC

• Wood lamp skin examination (difficult to evaluate)

• Skin scraping test
 PLANNING THERAPY
Therapy
• Erythromicine tab 3 x 500mg
• Miconazole cream 2 dd ue
Education
• Don’t wear tight clothes
• Keep the dryness of affected skin
• Keep hiegenitas
Follow up
• Evaluate lesion and complain
SKIN SCRAPINGS TEST

rod-shaped
gram-positive
bacteria
 FOLLOW UP
March 26th 2018 March 31st 2018

Brown spot on the right an left Brown spot on the left armpit
Complaints
armpits. No itching began to decrease

Physical Sharply demarcated Sharply demarcated

Examination hyperpigmented macule hyperpigmented macule

Picture
DISCUSSION
 DEFINITION

Erythrasma is a common skin condition affecting

the skin folds such as under the arms, in the groin and
between the toes.
The bacteria responsible for erythrasma are gram-
positive, non-spore-forming, aerobic or facultative
bacilli called Corynebacterium minutissimum.
 HISTORY

CASE THEORY
• Male • Erythrasma affects
males and females

• 64 years old patients • The incidence of

erythrasma increases
with age, but no age
group is immune to the
disease.
 HISTORY

CASE THEORY
• Patients live in the • Erythrasma is found more
tropical country frequently in the
subtropical and tropical
areas

• Brown spots on the • Common sites for

right and left armpits erythrasma are armpits,
groin and between the toes.
 HISTORY

CASE THEORY
• No itching • Infection commonly is
asymptomatic, but it
can be pruritic

• Sweats • One of the predisposing

factors of erythrasma is
excessive sweating /
hyperhidrosis
 DERMATOLOGICAL STATUS

CASE THEORY
• Regio • Regio
– Axillary dextra et sinistra – Common sites for erythrasma
are armpits, groin and
between the toes.
Intergluteal
fold, submammary, and
periumbilical skin may also
be affected.
 DERMATOLOGICAL STATUS

CASE THEORY
• Efflorescence • Efflorescence
– Sharply demarcated – The typical appearance of
hyperpigmented macule erythrasma is well-
demarcated, brown-red
macular patches. The skin
has a wrinkled appearance
with fine scales
 DERMATOLOGICAL STATUS

CASE THEORY

Axillary Dextra Axillary Sinistra

 DIFFERENTIAL DIAGNOSIS

Intertrigo Candidiasis

• Infections caused  yeast Candida albicans

• Dermatological status  erythematous, macerated plaques, satellite papules or
pustules
• Pottasium hydroxide  budding yeast cells with or without pseudohifa or hyphae

Seborrheic Dermatitis

• Occurs on the sebum-rich areas of the scalp, face, and trunk

• Skin lesions manifest as branny or greasy scaling over red, inflamed skin

Pityriasis versicolor

• Infections caused  fungal

• Wood lamp  yellow-green fluorescence may be observed in affected areas
• Pottasium hydroxide  hyphae and yeast cells that resemble spaghetti and meatballs
are observed
 DIAGNOSIS
CASE THEORY
• Wood lamp skin • Wood lamp skin
examination (difficult to examination: fluoresce a
evaluate) coral-pink colour
 DIAGNOSIS
CASE THEORY
• Skin scraping test: rod- • Swab or skin scrapings:
shaped gram-positive microscopy may reveal
bacteria gram-positive filamentous
rods. Methylene blue also
stains C minutissimum
 THERAPY
CASE THEORY
• Erythromicine tab 3 x • Erythrasma can be treated
500mg with antiseptic or topical
• Miconazole cream 2 dd ue antibiotic such as, fusidic
acid cream, clindamycin
solution, whitfield ointment
• Extensive infection can be
treated with
oral antibiotics,
including erythromycin
or tetracycline and usually
responds promptly.
 CONCLUSION

This patient was diagnosed Erythrasma because

there were sharply demarcated hyperpigmented
macule. Skin scrapping test was obtained rod-shaped
gram-positive bacteria, although wood lamp
examination difficult to evaluate.
Extensive infection can be treated with
oral antibiotics, including erythromycin or tetracycline
and usually responds promptly.
T H A N K Y O U