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Erythrasma

  • Author: Abdul-Ghani Kibbi, MD; Chief Editor: William D James, MD  more...
 
Updated: May 17, 2016
 

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.[1]

In a more recent study, two colonies of Corynebacterium aurimucosum and Microbacterium oxydans were isolated from the interdigital web of the left foot in a 78-year-old woman indicating that other species of microorganisms may be responsible for this condition.[2]

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Pathophysiology

Corynebacteria invade the upper third of the stratum corneum; under favorable conditions such as heat and humidity, these organisms proliferate. The stratum corneum is thickened. The organisms that cause erythrasma 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.

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Epidemiology

Frequency

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.[3]

In a study conducted in Turkey, the rate of erythrasma was found to be 46.7% among 122 patients with interdigital foot lesions.[4]

Race

The incidence of erythrasma is higher in black patients.

Sex

Both sexes are equally affected by erythrasma; however, the crural form of erythrasma is more common in men. A 2008 study found that interdigital erythrasma was more common in women (83% of 24 patients).[5]

Age

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

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Prognosis

The prognosis for erythrasma is excellent; however, the condition tends to recur if the predisposing factors are not eliminated.

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),[6] intravascular catheter–related infections (2 cases),[7] primary bacteremia (3 cases), peritoneal catheter–related infections (2 cases),[7, 8] endocarditis (2 cases),[9, 10] pyelonephritis (2 cases),[11, 12] cellulitis (1 case),[13] endophthalmitis (1 case),[14] arteriovenous fistula infection (1 case), cutaneous granuloma (1 case),[15] and meningitis (1 case).[16]

The first case of postoperative intraabdominal infection caused by Corynebacterium minutissimum in an immunocompetent adult host was reported and has been successfully treated with intravenous amoxicillin/sulbactam.[17]

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Patient Education

Patients with erythrasma should be instructed to keep the area dry.

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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)

Maria S Bou Sleiman, MD Resident Physician, Department of Dermatology, American University of Beirut Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

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, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Jeffrey Meffert, MD Associate 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, Texas Dermatological Society

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

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, Women's Dermatologic Society, Medical Dermatology Society

Disclosure: Nothing to disclose.

Fady G Haddad, MD Specialist Dermatologist, Dubai Healthcare City, UAE and AR Shamma Medical Center

Fady G Haddad, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Ruba Faik Bahhady, MD Senior Specialist, Department of Dermatology, American University of Beirut Medical Center

Disclosure: Nothing to disclose.

Acknowledgements

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.

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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