Erythrasma

Aka: Erythrasma, Cutaneous Erythrasma, Corynebacterium minutissimum

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II. Epidemiology

  1. Accounts for 17% of Bacterial skin Infections in Older Adults

III. Pathophysiology

  1. Caused by Corynebacterium minutissimum, a Gram Positive Rod that is a common skin colonizer
  2. C. minutissimum grows best in moist, hot environments (intertriginous areas)
  3. Regions of Erythrasma are also often coinfected with dermatophytes initially

IV. Risk Factors

  1. Similar to risks associated with Intertrigo
  2. Regions with excessive heat and moisture
  3. Comorbidity
    1. Older Adults
    2. Diabetes Mellitus
    3. Obesity
    4. Immunosuppression
    5. Hyperhidrosis
    6. Decreased hygiene

V. Symptoms

  1. Usually asymptomatic
  2. May be pruritic in some cases

VI. Signs

  1. Small red-brown, hyperpigmented Macules (may form larger patches)
    1. Minimal Scaling
  2. Distribution in intertriginous areas (moist, macerated areas)
    1. Interdigital web spaces
      1. Most common Bacterial foot infection
      2. Macerated interdigital skin is common
    2. Gluteal crease
    3. Inguinal area
    4. Axilla
    5. Inframammary

VII. Diagnosis

  1. Wood's Lamp: Fluoresces coral red
  2. Gram Stain: Gram Positive Rod with long filaments

VIII. Differential Diagnosis

  1. See Intertrigo
  2. See Interdigital Intertrigo Secondary Infection
  3. Cutaneous Candidiasis
  4. Dermatophytes
    1. Tinea Pedis
    2. Tinea Cruris
  5. Psoriasis

IX. Managment

  1. Antibiotics
    1. Erythromycin 250 mg orally qid for 5 days
    2. Clarithromycin 1 gram orally for 1 dose
  2. Topical Antifungal agents with activity in Erythrasma
    1. Miconazole
    2. Clotrimazole
    3. Econazole
  3. Treat coexisting Fungal Infection (see Intertrigo)
  4. Adjunctive topical agents
    1. Cleocin-T or Erythromycin gel
    2. Whitfield's Ointment
    3. Sodium fusidate ointment
    4. Antibacterial soap
    5. Chlorhexidine (Hibiclens)

X. Prevention

  1. See Intertrigo

XI. References

  1. Habif (2004) Clinical Dermatology, p. 419
  2. Daze (2025) Am Fam Physician 111(4): 373-4 [PubMed]
  3. Holdiness (2003) Am Fam Physician 67(2):254 [PubMed]
  4. Janniger (2005) Am Fam Physician 72:833-40 [PubMed]

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