eMedicine Specialties > Dermatology > Bacterial Infections

Erythrasma

Author: Abdul-Ghani Kibbi, MD, Chairman and Professor, Department of Dermatology, American University of Beirut Medical Center, Lebanon
Coauthor(s): Zenus Saleh, MD, Staff Physician, Department of Dermatology, American University of Beirut Medical Center; Fadi Haddad, MD, Specialist, Divisions of Dermatology, Tawam Hospital, United Arab Emirates
Contributor Information and Disclosures

Updated: Feb 27, 2007

Introduction

Background

Erythrasma is a chronic superficial infection of the intertriginous areas of the skin. The incriminated organism is Corynebacterium minutissimum, which usually is present as a normal human skin inhabitant. In 1996, Corynebacterium afermentans was reported in one case.

Pathophysiology

Corynebacteria invade the upper one-third of the stratum corneum; under favorable conditions such as heat and humidity, these organisms proliferate. The stratum corneum is thickened. The organisms are seen in the intercellular spaces as well as within cells, dissolving keratin fibrils. The coral red fluorescence of scales seen under Wood light is secondary to the production of porphyrin by these diphtheroids.

Frequency

International

The incidence of erythrasma is reported to be around 4%. This infection is observed all over the world; the widespread form is found more frequently in the subtropical and tropical areas than in other parts of the world.

Mortality/Morbidity

Erythrasma is usually a benign condition. However, it may become widespread and invasive in predisposed and immunocompromised individuals; this is very rare in immunocompetent hosts. In such individuals, this organism has caused infections other than erythrasma. These include abscess formation (3 cases), intravascular catheter–related infections (3 cases), primary bacteremia (3 cases), peritoneal catheter–related infections (2 cases), endocarditis (1 case), and pyelonephritis (1 case).

Race

The incidence is higher in black people.

Sex

Both sexes are equally affected; however, the crural form is more common in men.

Age

The incidence of erythrasma increases with age, but no age group is immune to the disease. The youngest patient reported to have this condition is a 1-year-old infant.

Clinical

History

  • Dark discoloration is usually limited to body folds that are naturally moist and occluded.
  • Infection commonly is asymptomatic, but it can be pruritic.
  • Duration ranges from months to years.
  • Widespread involvement of trunk and limbs is possible.

Physical

  • The typical appearance is well-demarcated, brown-red macular patches. The skin has a wrinkled appearance with fine scales (Image 1).
  • Infection commonly is located over inner thighs, crural region, scrotum, and toe webs.
  • Axillae, submammary area, periumbilical region, and intergluteal fold are less commonly involved.
  • Toe web lesions appear as maceration.

Causes

  • C minutissimum, a member of the normal skin flora, is the causative agent.
    • The bacterium is a lipophilic, gram-positive, non–spore-forming, aerobic, and catalase-positive diphtheroid.
    • C minutissimum ferments glucose, dextrose, sucrose, maltose, and mannitol.
  • Predisposing factors include the following:
    • Excessive sweating/hyperhidrosis
    • Delicate cutaneous barrier
    • Obesity
    • Diabetes mellitus
    • Warm climate
    • Poor hygiene
    • Advanced age
  • Other immunocompromised states

More on Erythrasma

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

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

  2. 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].

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

  4. 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].

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

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

  7. 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].

  8. 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].

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

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

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

  12. 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].

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

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

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Further Reading

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Keywords

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: Nothing to disclose.

Coauthor(s)

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.

Fadi Haddad, MD, Specialist, Divisions of Dermatology, Tawam Hospital, United Arab Emirates
Disclosure: Nothing to disclose.

Medical Editor

Robin Travers, MD, Professor, Department of Dermatology, Boston University School of Medicine
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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