Erythrasma

Last Updated: 2020-11-19

Author(s): Anzengruber, Navarini

Baerensprung 1862.

Baerensprung's disease.

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
    • Immunosuppression
    • Overweight
    • Hyperhidrosis
    • 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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  7. Macmillan AL, Sarkany I. SPECIFIC TOPICAL THEEAPY FOR ERYTHRASMA. Br J Dermatol 1970;82:507-9.
  8. Rho N-K, Kim B-J. A corynebacterial triad: Prevalence of erythrasma and trichomycosis axillaris in soldiers with pitted keratolysis. Journal of the American Academy of Dermatology 2008;58:S57-S8.