Erythrasma Medication

  • Author: Abdul-Ghani Kibbi, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: May 7, 2012
 

Medication Summary

The goals of pharmacotherapy for erythrasma are to reduce morbidity, eradicate the infection, and prevent complications.

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Anti-infectives

Class Summary

Antibacterial and/or antifungal agents are used to eradicate C minutissimum and possible concomitant infection. Erythromycin is the DOC. Infection may be treated with topical and/or oral agents. Therapy must be comprehensive and cover all likely pathogens in the context of this clinical setting. C minutissimum is generally susceptible to penicillins, first-generation cephalosporins, erythromycin, clindamycin, ciprofloxacin, tetracycline, and vancomycin. However, multiresistant strains have been isolated.[27, 28, 29, 30]

In a recent susceptibility study of 40 patients, several antibiotics were tested, including penicillin G, ampicillin, cefaclor, amoxicillin-clavulanate, ampicillin-sulbactam, tetracycline, erythromycin, ofloxacin, fusidic acid, levofloxacin, and azithromycin. The study revealed statistically significant resistance to erythromycin, azithromycin, penicillin, and ampicillin. Significant susceptibility was statistically found to amoxicillin-clavulanate, cefaclor, and fusidic acid.[31]

Because culture and antibiogram are not performed routinely in daily clinical practice, the recommended initial treatment is topical fusidic acid. If this drug is not available, then topical tetracycline may be an alternative. In cases of treatment failure, amoxicillin-clavulanate should be chosen for the systemic treatment.[31]

In a large double-blind, placebo-controlled, randomized trial, 151 patients older than 18 years were randomized into 5 groups and were given either erythromycin, single-dose clarithromycin, topical fusidic acid, placebo cream, or placebo tablets. Fusidic acid cream was significantly more effective than other therapies. Additionally, the group who received clarithromycin did better at 48 hours than did the group that received erythromycin. However, there was no statistical difference on day 7 and day 14.[32]

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Erythromycin (E.E.S., E-Mycin, Ery-Tab)

 

DOC that inhibits bacterial growth, possibly by blocking dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest.

In children, age, weight, and severity of infection determine proper dosage. When bid dosing is desired, half-total daily dose may be taken q12h. For more severe infections, double the dose.

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Clarithromycin (Biaxin)

 

Inhibits bacterial growth, possibly by blocking dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest.

Fusidic acid (Zeta)

 

Topical antibacterial that inhibits bacterial protein synthesis, causing bacterial death.

Use 2% cream.

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Miconazole topical (Femazole, Lotrimin, Monistat)

 

Damages fungal cell wall membrane by inhibiting biosynthesis of ergosterol. Membrane permeability is increased, causing nutrients to leak out and resulting in fungal cell death.

Lotion is preferred in intertriginous areas. If cream is used, apply sparingly to avoid maceration effects.

Use 2% cream.

Benzoic acid 6%, salicylic acid 3% (Whitfield's ointment)

 

Treats infection and inflammation associated with erythrasma.

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Clindamycin (Cleocin)

 

Has a bacteriostatic effect; interferes with bacterial protein synthesis similarly to erythromycin and chloramphenicol by binding to 50S subunit of bacterial ribosome.

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Tetracycline (Achromycin)

 

Inhibits cell growth by inhibiting mRNA translation. Binds to 16S part of 30S ribosomal subunit and prevents amino-acyl tRNA from binding to A site of ribosome. Binding is reversible in nature.

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Contributor Information and Disclosures
Author

Abdul-Ghani Kibbi, MD  Professor and Chair, Department of Dermatology, American University of Beirut Medical Center, Lebanon

Disclosure: Nothing to disclose.

Coauthor(s)

Ruba Faik Bahhady, MD  Senior Specialist, 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.

Specialty Editor Board

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.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster 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.

Jeffrey Meffert, MD  Assistant Clinical Professor of Dermatology, University of Texas School of Medicine at 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.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M 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, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

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Lichenification and hyperpigmentation are common. The skin occasionally has a wrinkled appearance with scales. KOH test results are negative. Courtesy of Michael Bryan, MD.
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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