eMedicine Specialties > Dermatology > Bacterial Infections

Erythrasma: Treatment & Medication

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

Treatment

Medical Care

Photodynamic therapy using red light (broadband, peak at 635 nm) has been reported to clear erythrasma in 23% of 13 patients and to improve erythrasma in the remaining patients.20

Medication

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

Anti-infectives

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.21,22,23,24


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.

Adult

250 mg PO qid or 500 mg PO bid for 7-14 d
2-4% solution: Apply to affected area bid for 4-6 wk

Pediatric

30-50 mg/kg/d PO bid for 7-10 d
2-4% solution: Apply to affected area as in adults

Coadministration may increase toxicity of theophylline, digoxin, bromocriptine, alfentanil, cisapride, felodipine, ergotamine, midazolam, triazolam, methylprednisolone, carbamazepine, and cyclosporine; may potentiate anticoagulant effects of warfarin; coadministration with lovastatin and simvastatin increases risk of rhabdomyolysis; cimetidine may increase levels of erythromycin; arrhythmias and increases in QTc intervals occur with disopyramide; no interactions reported with topical dosage form

Documented hypersensitivity; hepatic impairment

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Caution in liver disease; estolate formulation may cause cholestatic jaundice; GI adverse effects are common (give doses pc); discontinue use if nausea, vomiting, malaise, abdominal colic, or fever occur; 2-4% solution, discontinue if irritation or sensitivity occur


Clarithromycin (Biaxin)

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

Adult

1 g PO once

Pediatric

15 mg/kg PO once

Toxicity increases with coadministration of fluconazole, astemizole, and pimozide; clarithromycin effects decrease and GI adverse effects may increase with coadministration of rifabutin or rifampin; may increase toxicity of anticoagulants, cyclosporine, tacrolimus, digoxin, omeprazole, carbamazepine, ergot alkaloids, triazolam, HMG CoA-reductase inhibitors; cardiac arrhythmias may occur with coadministration of cisapride; plasma levels of certain benzodiazepines may increase, prolonging CNS depression; arrhythmias and increase in QTc intervals occur with disopyramide; coadministration with omeprazole may increase plasma levels of both agents

Documented hypersensitivity; coadministration of pimozide or cisapride

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Coadministration with ranitidine or bismuth citrate is not recommended with CrCl <25 mL/min; give half dose or increase dosing interval if CrCl <30 mL/min; diarrhea may be sign of pseudomembranous colitis; superinfections may occur with prolonged or repeated antibiotic therapies


Fusidic acid (Zeta)

Topical antibacterial that inhibits bacterial protein synthesis, causing bacterial death.
Use 2% cream.

Adult

Apply to affected area bid for 2 wk

Pediatric

Apply as in adults

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Discontinue if irritation or sensitivity occur


Miconazole (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.

Adult

Apply to affected area bid for 2 wk

Pediatric

Apply as in adults

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

If sensitivity or chemical irritation occurs, discontinue use; use only externally; avoid contact with eyes


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

Treats infection and inflammation associated with erythrasma.

Adult

Apply to affected area bid for 4 wk

Pediatric

Not established

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

For external use only


Clindamycin (Cleocin)

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

Adult

Apply 2% aqueous solution tid for 1 wk

Pediatric

Not established

Interacts with opiates and diphenoxylate plus atropine, resulting in slowing of peristalsis; may enhance action of neuromuscular blocking agents; coadministration with erythromycin leads to increased level of clindamycin

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Allergic skin reactions, severe colitis, neutropenia, and polyarthritis


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.

Adult

250 mg qid for 14 d

Pediatric

Not established

Interferes with bactericidal action of penicillins, renders oral contraceptives less effective, and potentiates effects of warfarin

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Esophagitis, allergic reactions, phototoxic reactions, renal toxicity, hemolytic anemia, pseudotumor cerebri, vestibular toxicity, and tooth discoloration

More on Erythrasma

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

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Further Reading

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Keywords

erythrasma, 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: 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.

 
 
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