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): 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

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.1

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.

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.2

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),3 intravascular catheter–related infections (2 cases),4 primary bacteremia (3 cases), peritoneal catheter–related infections (2 cases),4,5 endocarditis (2 cases),6,7 pyelonephritis (2 cases),8,9 cellulitis (1 case),10 endophthalmitis (1 case),11 arteriovenous fistula infection (1 case), cutaneous granuloma (1 case),12 and meningitis (1 case).13

Race

The incidence of erythrasma is higher in black people.

Sex

Both sexes are equally affected by erythrasma; however, the crural form of erythrasma 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 erythrasma is a 1-year-old infant.

Clinical

History

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

Physical

  • The typical appearance of erythrasma is well-demarcated, brown-red macular patches. The skin has a wrinkled appearance with fine scales (Media File 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 in erythrasma.
  • Toe web lesions appear as maceration.


Lichenification and hyperpigmentation are common....

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

[ CLOSE WINDOW ]
Lichenification and hyperpigmentation are common....

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

Causes

  • C minutissimum, a member of the normal skin flora, is the causative agent of erythrasma.
    • 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 for erythrasma include the following:
    • Excessive sweating/hyperhidrosis
    • Delicate cutaneous barrier
    • Obesity
    • Diabetes mellitus
    • Warm climate
    • Poor hygiene
    • Advanced age
  • Other immunocompromised states can predispose to erythrasma.

More on Erythrasma

Overview: Erythrasma
Differential Diagnoses & Workup: Erythrasma
Treatment & Medication: Erythrasma
Follow-up: Erythrasma
Multimedia: Erythrasma
References
[ CLOSE WINDOW ]

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].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

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

[ CLOSE WINDOW ]

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.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.