eMedicine Specialties > Dermatology > Bacterial Infections

Erythrasma: Differential Diagnoses & Workup

Author: Abdul-Ghani Kibbi, MD, Chairman and Professor, Department of Dermatology, American University of Beirut Medical Center, Lebanon
Coauthor(s): Ruba Faik Bahhady, MD, Resident Physician, Department of Dermatology, American University of Beirut Medical Center; Zenus Saleh, MD, Staff Physician, Department of Dermatology, American University of Beirut Medical Center; Fady G Haddad, MD, Consulting Staff, Division of Dermatology, American University of Beirut Medical Center, Dubai Healthcare City
Contributor Information and Disclosures

Updated: Aug 11, 2009

Differential Diagnoses

Acanthosis Nigricans
Seborrheic Dermatitis
Candidiasis, Cutaneous
Tinea Corporis
Contact Dermatitis, Allergic
Tinea Cruris
Contact Dermatitis, Irritant
Tinea Pedis
Intertrigo
Psoriasis, Plaque

Other Problems to Be Considered

Pityriasis versicolor14 : Noteworthy is the coexistence of erythrasma with pityriasis versicolor, as described in a 53-year-old woman in whom both infections  occurred in the axillary and genitocrural region.15
Pruritus ani16
Seborrheic dermatitis17  

Workup

Laboratory Studies

  • Wood light examination of erythrasma lesions reveals coral-red fluorescence of lesions. Results may be negative if the patient bathed prior to presentation.18


Under Wood lamp examination, the porphyrins produ...

Under Wood lamp examination, the porphyrins produced by the bacteria fluoresce with a coral pink color. A small focus is visible on this photo. If the patient recently has bathed, the pigment may be washed away. In suspicious cases, a repeat examination the following day may be necessary. Courtesy of Michael Bryan, MD.

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Under Wood lamp examination, the porphyrins produ...

Under Wood lamp examination, the porphyrins produced by the bacteria fluoresce with a coral pink color. A small focus is visible on this photo. If the patient recently has bathed, the pigment may be washed away. In suspicious cases, a repeat examination the following day may be necessary. Courtesy of Michael Bryan, MD.

  • Gram staining reveals of erythrasma lesions gram-positive filamentous rods.
  • In culture media composed of 20% fetal bovine serum, 2% agar, 78% tissue culture medium #199, and 0.05% tris, the organisms grow as nonhemolytic, 1- to 1.5-mm smooth colonies.
  • Methylene blue stain may be used to highlight both the fungal spores of pityriasis versicolor and the curved or club-shaped bacterial rods of C minutissimum, the causative agent of erythrasma, in case both organisms coexist.15

Histologic Findings

The diphtheroid bacteria that cause erythrasma are present in the horny layer as rods and filaments.19

More on Erythrasma

Overview: Erythrasma
Differential Diagnoses & Workup: Erythrasma
Treatment & Medication: Erythrasma
Follow-up: Erythrasma
Multimedia: Erythrasma
References
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References

  1. Dellion S, Morel P, Vignon-Pennamen D, Felten A. Erythrasma owing to an unusual pathogen. Arch Dermatol. Jun 1996;132(6):716-7. [Medline].

  2. Sarkany I, Taplin D, Blank H. Incidence and bacteriology of erythrasma. Arch Dermatol. May 1962;85:578-82. [Medline].

  3. Bandera A, Gori A, Rossi MC, et al. A case of costochondral abscess due to Corynebacterium minutissimum in an HIV-infected patient. J Infect. Jul 2000;41(1):103-5. [Medline].

  4. Van Bosterhaut B, Cuvelier R, Serruys E, Pouthier F, Wauters G. Three cases of opportunistic infection caused by propionic acid producing Corynebacterium minutissimum. Eur J Clin Microbiol Infect Dis. Jul 1992;11(7):628-31. [Medline].

  5. Fernandez Giron F, Saavedra Martin JM, Benítez Sanchez M, Fernandez Mora F, Rodriguez Gomez E. Corynebacterium minutissimum peritonitis in a CAPD patient. Perit Dial Int. May-Jun 1998;18(3):345-6. [Medline].

  6. Aperis G, Moyssakis I. Corynebacterium minutissimum endocarditis: a case report and review. J Infect. Feb 2007;54(2):e79-81. [Medline].

  7. Herschorn BJ, Brucker AJ. Embolic retinopathy due to Corynebacterium minutissimum endocarditis. Br J Ophthalmol. Jan 1985;69(1):29-31. [Medline].

  8. Ahmad NM, Ahmad KM. Corynebacterium minutissimum pyelonephritis with associated bacteraemia: a case report and review of literature. J Infect. Dec 2005;51(5):e299-303. [Medline].

  9. Craig J, Grigor W, Doyle B, Arnold D. Pyelonephritis caused by Corynebacterium minutissimum. Pediatr Infect Dis J. Dec 1994;13(12):1151-2. [Medline].

  10. Granok AB, Benjamin P, Garrett LS. Corynebacterium minutissimum bacteremia in an immunocompetent host with cellulitis. Clin Infect Dis. Aug 15 2002;35(4):e40-2. [Medline].

  11. Arsan AK, Sizmaz S, Ozkan SB, Duman S. Corynebacterium minutissimum endophthalmitis: management with antibiotic irrigation of the capsular bag. Int Ophthalmol. 1995-1996;19(5):313-6. [Medline].

  12. Santos-Juanes J, Galache C, Martinez-Cordero A, et al. Cutaneous granulomas caused by corynebacterium minutissimum in an HIV-infected man. J Eur Acad Dermatol Venereol. Nov 2002;16(6):643-5. [Medline].

  13. Dalal A, Likhi R. Corynebacterium minutissimum bacteremia and meningitis: a case report and review of literature. J Infect. Jan 2008;56(1):77-9. [Medline].

  14. Aste N, Pau M, Aste N. Pityriasis versicolor on the groin mimicking erythrasma. Mycoses. Jun 2004;47(5-6):249-51. [Medline].

  15. Karakatsanis G, Vakirlis E, Kastoridou C, Devliotou-Panagiotidou D. Coexistence of pityriasis versicolor and erythrasma. Mycoses. Aug 2004;47(7):343-5. [Medline].

  16. Bowyer A, McColl I. Erythrasma and pruritus ani. Acta Derm Venereol. 1971;51(6):444-7. [Medline].

  17. Marinella MA. Erythrasma and seborrheic dermatitis of the groin. Am Fam Physician. Nov 15 1995;52(7):2012. [Medline].

  18. Mattox TF, Rutgers J, Yoshimori RN, Bhatia NN. Nonfluorescent erythrasma of the vulva. Obstet Gynecol. May 1993;81(5 (Pt 2)):862-4. [Medline].

  19. Montes LF, Black SH, McBride ME. Bacterial invasion of the stratum corneum in erythrasma. I. Ultrastructural evidence for a keratolytic action experted by Corynebacterium minutissimum. J Invest Dermatol. Nov 1967;49(5):474-85. [Medline].

  20. Darras-Vercambre S, Carpentier O, Vincent P, Bonnevalle A, Thomas P. Photodynamic action of red light for treatment of erythrasma: preliminary results. Photodermatol Photoimmunol Photomed. Jun 2006;22(3):153-6. [Medline].

  21. Clayton YM, Connor BL. Comparison of clotrimazole cream, Whitfield's ointment and Nystatin ointment for the topical treatment of ringworm infections, pityriasis versicolor, erythrasma and candidiasis. Br J Dermatol. Sep 1973;89(3):297-303. [Medline].

  22. Hamann K, Thorn P. Systemic or local treatment of erythrasma? A comparison between erythromycin tablets and Fucidin cream in general practice. Scand J Prim Health Care. Mar 1991;9(1):35-9. [Medline].

  23. Holdiness MR. Management of cutaneous erythrasma. Drugs. 2002;62(8):1131-41. [Medline].

  24. Wharton JR, Wilson PL, Kincannon JM. Erythrasma treated with single-dose clarithromycin. Arch Dermatol. Jun 1998;134(6):671-2. [Medline].

  25. Golledge CL, Phillips G. Corynebacterium minutissimum infection. J Infect. Jul 1991;23(1):73-6. [Medline].

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Further Reading

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Keywords

erythrasma, Corynebacterium minutissimum, C minutissimum, Corynebacterium afermentans, C afermentans

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Contributor Information and Disclosures

Author

Abdul-Ghani Kibbi, MD, Chairman and Professor, Department of Dermatology, American University of Beirut Medical Center, Lebanon
Disclosure: none None None

Coauthor(s)

Ruba Faik Bahhady, MD, Resident Physician, Department of Dermatology, American University of Beirut Medical Center
Disclosure: Nothing to disclose.

Zenus Saleh, MD, Staff Physician, Department of Dermatology, American University of Beirut Medical Center
Zenus Saleh, MD is a member of the following medical societies: Alpha Omega Alpha
Disclosure: Nothing to disclose.

Fady G Haddad, MD, Consulting Staff, Division of Dermatology, American University of Beirut Medical Center, Dubai Healthcare City
Fady G Haddad, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Medical Editor

Robin Travers, MD, Assistant Professor of Medicine (Dermatology), Dartmouth University School of Medicine; Staff Dermatologist, New England Baptist Hospital; Private Practice, SkinCare Physicians
Robin Travers, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Informatics Association, Massachusetts Medical Society, Medical Dermatology Society, and Women's Dermatologic Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Jeffrey Meffert, MD, Assistant Clinical Professor of Dermatology, University of Texas Health Science Center-San Antonio
Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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