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.

Immunosuppressed patients with erythrasma and the risk of complications are of special concern. Evaluate and treat possible concomitant infection. Suspect diabetes in recurrent erythrasma. Address and modify risk factors for successful treatment.

Physical Examination

The typical appearance of erythrasma is well-demarcated, brown-red macular patches. The skin has a wrinkled appearance with fine scales (see the image below).

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

View Media Gallery

Infection commonly is located on the inner thighs, crural region, scrotum, and toe webs. The axillae, submammary area, periumbilical region, and intergluteal folds are less commonly involved in erythrasma. Toe web lesions appear as maceration, with the fourth interdigital space most frequently affected.^[8]

Owing to the association of erythrasma with other corynebacterial skin infections such as pitted keratolysis and trichomycosis axillaris, all body folds and feet should be screened. This association has been investigated in 53 patients with pitted keratolysis who had skin signs of other corynebacterial infections. Erythrasma was encountered in 2 of 53 of this cohort in male patients, whereas trichobacteriosis was noted in 4 of 53. One patient presented simultaneously with all the three conditions.^[23]

Complications

Note the following possible complications:

Fatal septicemia in immunocompromised patients with erythrasma
Infective endocarditis in valvular heart disease patients with erythrasma
Postsurgical wound infection in erythrasma patients

Differential Diagnoses

Dellion S, Morel P, Vignon-Pennamen D, Felten A. Erythrasma owing to an unusual pathogen. Arch Dermatol. 1996 Jun. 132(6):716-7. [QxMD MEDLINE Link].
Yasuma A, Ochiai T, Azuma M, Nishiyama H, Kikuchi K, Kondo M, et al. Exogenous coproporphyrin III production by Corynebacterium aurimucosum and Microbacterium oxydans in erythrasma lesions. J Med Microbiol. 2011 Jul. 60 (Pt 7):1038-42. [QxMD MEDLINE Link].
Penton PK, Tyagi E, Humrighouse BW, McQuiston JR. Complete Genome Sequence of Corynebacterium minutissimum, an Opportunistic Pathogen and the Causative Agent of Erythrasma. Genome Announc. 2015 Mar 19. 3 (2):[QxMD MEDLINE Link].
Sarkany I, Taplin D, Blank H. Incidence and bacteriology of erythrasma. Arch Dermatol. 1962 May. 85:578-82. [QxMD MEDLINE Link].
Inci M, Serarslan G, Ozer B, et al. The prevalence of interdigital erythrasma in southern region of Turkey. J Eur Acad Dermatol Venereol. 2011 Oct 7. [QxMD MEDLINE Link].
Halvaee S, Daie Ghazvini R, Hashemi SJ, Zibafar E, Yekaninejad S, Geramishoar M, et al. Investigation of Intertriginous Mycotic and Pseudomycotic (Erythrasma) Infections and Their Causative Agents with Emphasize on Clinical Presentations. Iran J Public Health. 2018 Sep. 47 (9):1406-1412. [QxMD MEDLINE Link].
Rao AG, Karanam A, Farheen SS. Erythrasma of Palm: Presentation at the Rare Site. Indian Dermatol Online J. 2019 May-Jun. 10 (3):356-357. [QxMD MEDLINE Link].
Morales-Trujillo ML, Arenas R, Arroyo S. [Interdigital erythrasma: clinical, epidemiologic, and microbiologic findings]. Actas Dermosifiliogr. 2008 Jul-Aug. 99(6):469-73. [QxMD MEDLINE Link].
Pinto M, Hundi GK, Bhat RM, Bala NK, Dandekeri S, Martis J, et al. Clinical and epidemiological features of coryneform skin infections at a tertiary hospital. Indian Dermatol Online J. 2016 May-Jun. 7 (3):168-73. [QxMD MEDLINE Link].
Bandera A, Gori A, Rossi MC, et al. A case of costochondral abscess due to Corynebacterium minutissimum in an HIV-infected patient. J Infect. 2000 Jul. 41(1):103-5. [QxMD MEDLINE Link].
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. 1992 Jul. 11(7):628-31. [QxMD MEDLINE Link].
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. 1998 May-Jun. 18(3):345-6. [QxMD MEDLINE Link].
Aperis G, Moyssakis I. Corynebacterium minutissimum endocarditis: a case report and review. J Infect. 2007 Feb. 54(2):e79-81. [QxMD MEDLINE Link].
Herschorn BJ, Brucker AJ. Embolic retinopathy due to Corynebacterium minutissimum endocarditis. Br J Ophthalmol. 1985 Jan. 69(1):29-31. [QxMD MEDLINE Link].
Ahmad NM, Ahmad KM. Corynebacterium minutissimum pyelonephritis with associated bacteraemia: a case report and review of literature. J Infect. 2005 Dec. 51(5):e299-303. [QxMD MEDLINE Link].
Craig J, Grigor W, Doyle B, Arnold D. Pyelonephritis caused by Corynebacterium minutissimum. Pediatr Infect Dis J. 1994 Dec. 13(12):1151-2. [QxMD MEDLINE Link].
Granok AB, Benjamin P, Garrett LS. Corynebacterium minutissimum bacteremia in an immunocompetent host with cellulitis. Clin Infect Dis. 2002 Aug 15. 35(4):e40-2. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. 2002 Nov. 16(6):643-5. [QxMD MEDLINE Link].
Dalal A, Likhi R. Corynebacterium minutissimum bacteremia and meningitis: a case report and review of literature. J Infect. 2008 Jan. 56(1):77-9. [QxMD MEDLINE Link].
Shin JY, Lee WK, Seo YH, Park YS. Postoperative Abdominal Infection Caused by Corynebacterium minutissimum. Infect Chemother. 2014 Dec. 46 (4):261-3. [QxMD MEDLINE Link].
Groves JB, Freeman AM. Erythrasma. StatPearls [Internet]. 2020 Jan. [QxMD MEDLINE Link]. [Full Text].
Blaise G, Nikkels AF, Hermanns-Lê T, Nikkels-Tassoudji N, Piérard GE. Corynebacterium-associated skin infections. Int J Dermatol. 2008 Sep. 47 (9):884-90. [QxMD MEDLINE Link].
Aste N, Pau M, Aste N. Pityriasis versicolor on the groin mimicking erythrasma. Mycoses. 2004 Jun. 47(5-6):249-51. [QxMD MEDLINE Link].
Karakatsanis G, Vakirlis E, Kastoridou C, Devliotou-Panagiotidou D. Coexistence of pityriasis versicolor and erythrasma. Mycoses. 2004 Aug. 47(7):343-5. [QxMD MEDLINE Link].
Bowyer A, McColl I. Erythrasma and pruritus ani. Acta Derm Venereol. 1971. 51(6):444-7. [QxMD MEDLINE Link].
Marinella MA. Erythrasma and seborrheic dermatitis of the groin. Am Fam Physician. 1995 Nov 15. 52(7):2012. [QxMD MEDLINE Link].
Rho NK, Kim BJ. A corynebacterial triad: Prevalence of erythrasma and trichomycosis axillaris in soldiers with pitted keratolysis. J Am Acad Dermatol. 2008 Feb. 58(2 Suppl):S57-8. [QxMD MEDLINE Link].
Finch J. Case of trichomycosis axillaris and erythrasma. J Drugs Dermatol. 2011 Dec. 10(12):1472-3. [QxMD MEDLINE Link].
Polat M, İlhan MN. The prevalence of interdigital erythrasma: a prospective study from an outpatient clinic in Turkey. J Am Podiatr Med Assoc. 2015 Mar. 105 (2):121-4. [QxMD MEDLINE Link].
Mattox TF, Rutgers J, Yoshimori RN, Bhatia NN. Nonfluorescent erythrasma of the vulva. Obstet Gynecol. 1993 May. 81(5 (Pt 2)):862-4. [QxMD MEDLINE Link].
Yasuma A, Ochiai T, Azuma M, et al. Exogenous coproporphyrin III production by Corynebacterium aurimucosum and Microbacterium oxydans in erythrasma lesions. J Med Microbiol. 2011 Jul. 60:1038-42. [QxMD MEDLINE Link].
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. 1967 Nov. 49(5):474-85. [QxMD MEDLINE Link].
Greywal T, Cohen PR. Erythrasma: A report of nine men successfully managed with mupirocin 2% ointment monotherapy. Dermatol Online J. 2017 May 15. 23 (5):[QxMD MEDLINE Link].
Ramírez-Hobak L, Moreno-Coutiño G, Arenas-Guzmán R, Gorzelewski A, Fernández-Martínez R. [Treatment of interdigital foot Erythrasma with ozonated olive oil]. Rev Med Inst Mex Seguro Soc. 2016 Jul-Aug. 54 (4):458-61. [QxMD MEDLINE Link].
Turk BG, Turkmen M, Aytimur D. Antibiotic susceptibility of Corynebacterium minutissimum isolated from lesions of Turkish patients with erythrasma. J Am Acad Dermatol. 2011 Dec. 65(6):1230-1. [QxMD MEDLINE Link].
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. 1973 Sep. 89(3):297-303. [QxMD MEDLINE Link].
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. 1991 Mar. 9(1):35-9. [QxMD MEDLINE Link].
Holdiness MR. Management of cutaneous erythrasma. Drugs. 2002. 62(8):1131-41. [QxMD MEDLINE Link].
Wharton JR, Wilson PL, Kincannon JM. Erythrasma treated with single-dose clarithromycin. Arch Dermatol. 1998 Jun. 134(6):671-2. [QxMD MEDLINE Link].
Avci O, Tanyildizi T, Kusku E. A comparison between the effectiveness of erythromycin, single-dose clarithromycin and topical fusidic acid in the treatment of erythrasma. J Dermatolog Treat. 2011 Sep 18. [QxMD MEDLINE Link].
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. 2006 Jun. 22(3):153-6. [QxMD MEDLINE Link].

Media Gallery

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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Author

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

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.

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: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

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

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.

Maria S Bou Sleiman, MD Resident Physician, 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.