Last Updated: 2020-11-19
Superficial infection with the gram-positive, aerobic Bacillius corynebacterium minutissimum.
- Prevalence: 4-6% of the total population in Central Europe, higher prevalence in tropical zones
- Older studies from England and New Zealand put the prevalence at around 20%.
- Rarely seen in children
- Frequently healthy patients are affected
- Predisposing factors:
- Male sex
- Diabetes mellitus
- Greater age
- High air humidity
- Warm environment
- Insufficient hygiene
- Pathogen: Corynebacterium minutissimum, which produces porphyrin. In the wood light a red fluorescence is visible
- Through skin defects the bacteria penetrate into the upper stratum corneum
- Up to 10.0 cm in size, sharply defined, in the course of time partly confluent, often pruritic reddish-brown maculae and later plaques with fine-lamellar scaling. The itching is favoured by sweating and prolonged sitting. The disease is often associated with bromhidrosis, keratoma sulcatum and trichobacteriosis axillaris.
- In the interdigital space between the toes, corynebacteria are the most common cause of bacterial infections. At the same time there can also be an interdigital mycosis
- The discoid form is not limited to the intertriginous areas. Discoid erythrasma is more common in women with black skin in tropical latitudes
- If erythrasma occurs in the genital or anal area, the latter often causes chronic pruritus
- Clinical features
- Wood light examination: coral red fluorescence (Pat. should not have bathed shortly before, because the porphyrins are water soluble. The test would be false negative in this case).
- Pathogen detection in a tear-off procedure with Tesafilm
- No Gram staining, culture or biopsy necessary
- KOH e.g. Tinea interdigitalis
- HIV test
Intertriginal (groin, axilla, anal, abdominal fold, submammary, large labia, scrotum, thigh and interdigital space).
- The bacteria can often be detected in the horny layer. In addition, a discrete perivascular infiltrate
- Culture (possible, but not necessary for diagnosis)
- Acid soaps
- No fatty ointments
- Hyperpigmentations often remain visible for several weeks even after the pathogens have been eliminated!
- Thorough daily skin cleansing with water and syndets
- Topical therapy
- Clotrimazole cream 2-3x daily
- Alternative: Ketoconazole cream 2-3x daily
- Alternative: Ciclopirox cream 2-3x daily
- Alternative: Erythromycin cream 2-3x daily
- Systemic therapy
- Erythromycin p.o. 500 mg 3x a day maximum dose: 4 g/d (adult), 40-100 mg/kg bw/day (5-12 yrs)
- Weight reduction
- Treatment of hyperhidrosis
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