ERYTHRASMA

DERMATOVENEROLOGY DEPARTMENT
MEDICAL FACULTY UKRIDA UNIVERSITY

KUDUS, 1-9-2014


Supervisor:
INTRODUCTION
Definition:
Erythrasma is a common superficial bacterial
infection of the skin characterized by well-difened but
irregular reddish brown patches, occuring in the
intertriginous areas, or by fissuring and white maceration in
the toe clefts.

EPIDEMIOLOGY
1. The incidence of erythrasma is reported to be around 4%
2. The widespread form is found more frequently in the
subtropical and tropical areas
3. The incidence of erythrasma increases with age
and higher in black people
4. Men and women are equally affected; the crural
form is more common in men and the interdigital form
is more common in women (83% of 24 patients).
ETIOLOGY
The incriminated organism is Corynebacterium minutissimum,
which usually is present as a normal human skin inhabitant.
Prediposing Factors: Humid cutaneous microclimate,
warm and/or humid climate or season; occlusive
clothing/shoes; obesity; diabetes mellitus; hiperhydrosis;
poor hygiene; and immunocompromised states.
PATHOGENESIS
Corynebacterium
minutissimum
dispersed over the
skin surface
In heat and
humidity
conditions: these
organisms
proliferate
Invade the upper
third of the
stratum corneum
Invade
intracellular
spaces
Penetrating
superficial
cornified cells and
keratinized cells
Hyperkeratotic
and likely
keratolytic
processes
Stratum corneum
is thickened
Lichenification
and
hyperpigmentation
ERYTHRASMA
CLINICAL MANIFESTATION














Figure 1. A. Sharply marginated, red patch in the axilla.
B. This macerated interdigital web-space.
A B
Commonly asymptomatic
Duration: weeks to months to years
Frequently misdiagnosed as tinea cruris
or pedis
DIAGNOSIS
1. Anamnesis :
Site of predilection
Toe webspaces
Inguinal folds (inner thigs)
Axilla
Groin
Intergluteal
Inframammary
Skin Lesion
Patches, sharply
marginated, macerated,
eroded, fissured, red or
brownish red.
Pruriticexcoriation,
lichenification
DIAGNOSIS
2. Physical examination:
DIAGNOSIS
3. Laboratory examinations:
a. Wood Lamp: Characteristic coral-red fluorescence (attributed to
coproporphyrin III). May not be present if patient has bathed recently.

Figure 2. A. Coral-red fluoresence of interdigital lesion
B. Coral-red fluoresence of inguinal (crural) lesion
DIAGNOSIS
b. Direct Microscopy: Negative for
fungal forms on KOH preparation of
skin scraping.









Figure 4. KOH preparation of skin
scraping show fine filaments of
Corynebacterium minutissimum.
c. Bacterial Culture:
Heavy growth of Corynebacterium.
Rules out Staphylococcus aureus,
group A or group B Streptococcus,
and Candida infection.
Pseudomonas aeruginosa webspace
infection (feet) is also present.

DIFFERENTIAL DIAGNOSIS
1. Pityriasis versicolor
Figure 5.
A. Pityriasis versicolor: These
lesion are darker (hyperemia
secondary inflammatory
response and increased
melanin).
B. Spaghetti and meatballs
appearence of Malassezia in
KOH preparation.
A
B
DIFFERENTIAL DIAGNOSIS
Figure 6.
2. Tinea Cruris: Blotchy
erythema with areas of
atrophy and scale on the right
medial upper thigh boerdering
the inguinal area.
3. Tinea Pedis (interdigital
type): Hyperkeratotic and
macerated (hydration of the
stratum corneum).
2.
3.
Tinea Pedis
(interdigital
type)
Tinea Cruris
Pityriasis
Versicolor
Site of
Predilection
Most: between
fourth and fifth
toes
Groins and
thighs, may
extend to
buttocks
Upper trunk,
upper arms, neck,
abdomen, axillae,
groins, thighs,
genitalia
Wood Lamp
Yellow-green Yellow-green
Blue-green
(yellowish white
or copper-orange)
Direct
microscopy
+ (septated
hyphae and
spora)
+ (septated
hyphae and
spora)
Spagetthi and
meatballs
apperance
Culture
Dermatophytes
can be isolated
Dermatophytes
can be isolated

Malassezia furfur
TREATMENT
1. Prevention/Prophylaxis: Wash with benzoyl
peroxide. Medicated powders. Topical antiseptic alcohol gels:
isopropyl, ethanol.

2. Topical Therapy: Preferable.
Benzoyl peroxide (2,5 %) gel daily, after showering, for 7 days
Topical erythromycin or clindamycin solution twice daily for 7
days
Sodium fusidate ointment, mupirocin ointment or cream
Benzoic acid cream (6%) and salicylic acid cream (3%)
Topical antifungal agents: clotrimazole, miconazole, econazole,
or ketoconazole (2%)
TREATMENT
3. Systemic Antibiotic Therapy:
Erythromycin:
Children: 30-50 mg/kgBW/day 7-10 days
Adult: 4 x 250 mg/day 2-3 weeks
Clarithromycin: 1 gram single dose
Tetracylin: 250 mg for 7 days
COMPLICATION & PROGNOSIS
Complication
Fatal septicemia
Infective
endocarditis
Postsurgical wound
infection
Prognosis
Excellent
The condition tends
to recur if the
predisposing factors
are not eliminated