Erythrasma

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

1. Somerville DA. Erythrasma in normal young adults. J Med Microbiol 1970;3:57-64.
2. Allen S, Christmas TI, McKinney W, Parr D, Oliver GF. The Auckland skin clinic tinea pedis and erythrasma study. N Z Med J 1990;103:391-3.
3. Blaise G, Nikkels AF, Hermanns-Le T, Nikkels-Tassoudji N, Pierard GE. Corynebacterium-associated skin infections. Int J Dermatol 2008;47:884-90.
4. Holdiness MR. Management of cutaneous erythrasma. Drugs 2002;62:1131-41.
5. Mattox TF, Rutgers J, Yoshimori RN, Bhatia NN. Nonfluorescent erythrasma of the vulva. Obstet Gynecol 1993;81:862-4.
6. Hamann K, Thorn P. Systemic or Local Treatment of Erythrasma? A comparison between Erythromycin Tablets and Fucidin R Cream in General Practice. Scandinavian Journal of Primary Health Care 1991;9:35-9.
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.