Erythrasma Treatment & Management

Updated: Sep 10, 2018
  • Author: Abdul-Ghani Kibbi, MD; Chief Editor: William D James, MD  more...
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Medical Care

Infection may be treated with topical and/or oral agents. First-line therapy is topical erythromycin or clindamycin, or fusidic acid cream or miconazole cream. However, fusidic acid is not available in the United States, so topical treatment with the other agents mentioned is the standard of care in the United States. Oral erythromycin is usually effective and is a good second-line therapy, as is single-dose clarithromycin or amoxicillin-clavulanate, for systemic treatment. [29] 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. [30, 31, 32, 33] In a susceptibility study of 40 patients, several antibiotics were tested, including penicillin G, ampicillin, cefaclor, amoxicillin-clavulanate, ampicillin-sulbactam, tetracycline, erythromycin, ofloxacin, fusidic acid, levofloxacin, and azithromycin. The study revealed statistically significant resistance to erythromycin, azithromycin, penicillin, and ampicillin. Significant susceptibility was statistically found to amoxicillin-clavulanate, cefaclor, and fusidic acid. [29]

In a large double-blind, placebo-controlled, randomized trial, 151 patients older than 18 years were randomized into five groups and were given either erythromycin, single-dose clarithromycin, topical fusidic acid, placebo cream, or placebo tablets. Fusidic acid cream was significantly more effective than other therapies. Additionally, the group that received clarithromycin did better at 48 hours than did the group that received erythromycin. However, there was no statistical difference on day 7 and day 14. [34]

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; however, it is not the treatment of choice.