Diagnostic Considerations

Consider the following:

Pityriasis versicolor ^[24]: Noteworthy is the coexistence of erythrasma with pityriasis versicolor, as described in a 53-year-old woman in whom both infections occurred in the axillary and genitocrural region. ^[25]
Pruritus ani ^[26]
Seborrheic dermatitis ^[27]

A prospective study was conducted on 842 Korean male soldiers in whom a high prevalence of pitted keratolysis—a corynebacterial infection—was noted. This infection remarkably coexisted with other etiologically related dermatoses of the skin, including erythrasma and trichomycosis axillaris occurring at a higher rate than expected.^{[28, 29]}

It is highly recommended to perform a direct KOH examination to exclude dermatophytosis because 31.6-62% of patients with erythrasma may have a concurrent infection with a dermatophyte. This has been shown in one study where Trichophyton rubrum (81.25%), Trichophyton mentagrophytes (6.25%), and Candida species (12.5%) were demonstrated.^[30]

Differential Diagnoses

Workup

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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.