Erythrasma 

  • Author: Abdul-Ghani Kibbi, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: May 17, 2010
 

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]

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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

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. A 2008 study found that interdigital erythrasma was more common in women (83% of 24 patients).[14]

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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Contributor Information and Disclosures
Author

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

Disclosure: none None None

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 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 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.

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, 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.

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. Morales-Trujillo ML, Arenas R, Arroyo S. [Interdigital erythrasma: clinical, epidemiologic, and microbiologic findings]. Actas Dermosifiliogr. Jul-Aug 2008;99(6):469-73. [Medline].

  15. Rho NK, Kim BJ. A corynebacterial triad: Prevalence of erythrasma and trichomycosis axillaris in soldiers with pitted keratolysis. J Am Acad Dermatol. Feb 2008;58(2 Suppl):S57-8. [Medline].

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

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

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

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

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

  21. 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].

  22. 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].

  23. 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].

  24. 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].

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

  26. 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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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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