Published on 19/03/2015 by admin
Filed under Dermatology
Last modified 22/04/2025
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Melissa C. Barkham
Evidence Levels: A Double-blind study B Clinical trial ≥ 20 subjects C Clinical trial < 20 subjects D Series ≥ 5 subjects E Anecdotal case reports
In its most typical form, erythrasma is characterized by well-defined reddish-brown flexural plaques which show fine scaling and no tendency to central clearing. It may also present with maceration of the toe webs.
The responsible organism, Corynebacterium minutissimum, is an inhabitant of normal human skin. Factors that predispose to clinically apparent infection include diabetes mellitus, obesity, old age, and a humid environment.
Erythrasma is often a trivial infection, but therapy may be requested because of the cosmetic appearance or because of pruritus. Co-infection with dermatophyte fungi or Candida albicans is common and may influence the choice of treatment.
Fusidic acid cream is the topical treatment of choice where no concomitant yeast or fungal infection is found. It is both effective and well tolerated.
Topical imidazoles (miconazole, clotrimazole) are well tolerated and also effective against concomitant fungal or yeast infection.
Whitfield’s ointment (benzoic acid compound) is effective but is less well tolerated than other topical treatments.
When the disease is extensive or when compliance with topical therapy is unlikely, oral antibiotics such as single dose clarithromycin or oral erythromycin should be considered.
A combination of oral and topical treatment may be required for stubborn infections, particularly of the toe webs.
Examination under Wood’s light
Potassium hydroxide preparation of skin scrapings
Fasting serum glucose
Rapid confirmation of the diagnosis is achieved by examination of the skin under Wood’s (long-wave ultraviolet) light. The characteristic coral-red fluorescence observed is due to the production of coproporphyrin III by the organism. Fluorescence may not be seen if the patient has bathed immediately prior to examination. Culture is unreliable because the organism does not always grow satisfactorily. Microscopy of skin scrapings is performed to seek evidence of concomitant infection, such as the presence of fungal hyphae or yeasts. Consider underlying diabetes mellitus if erythrasma is severe or recurrent.
Avci O, Tanyildizi T, Kusku E. J Dermatolog Treat [Epub]. 2011.
A complete response was observed in 30/31 patients treated with 2% fusidic acid cream twice daily for 14 days in this double-blind placebo-controlled trial. The response was superior to placebo and to oral antibiotics in this study.
Pitcher DG, Noble WC, Seville RH. Clin Exp Dermatol 1979; 4: 453–6.
Twenty-three patients were treated with miconazole cream and 25 with Whitfield’s ointment twice daily for 2 weeks. In both groups a clearance rate of 88% was obtained, but irritation was a problem with Whitfield’s ointment.
Clayton YM, Knight AG. Clin Exp Dermatol 1976; 1: 225–32.
This was a comparison of the two preparations in dermatophyte infection, but 11 patients with erythrasma were also studied: six treated with miconazole, five with clotrimazole, both twice daily. All patients in both groups were free of infection at 4 weeks.
Cochran RJ, Rosen T, Landers T. Int J Dermatol 1981; 20: 562–4.
Two cases cleared with two or three times daily application of 2% aqueous clindamycin solution for 1 week. No recurrence was noted 6 weeks later.
Hamann K, Thorn P. Scand J Prim Health Care 1991; 9: 35–9.
This double-blind trial compared 14 days’ treatment with erythromycin 500 mg twice daily, 2% fusidic acid cream twice daily, and placebo. Four weeks after treatment 18 of 21 patients with erythromycin and 23 of 25 with fusidic acid cream were cured. Both were better than placebo.
Avci O, Tanyildizi T, Kusku E. J Dermatolog Treat 2011 [Epub].
A complete response was seen in 16/30 patients after erythromycin 1 g daily for 14 days, and in 20/30 patients 14 days after a single dose of clarithromycin 1 g. Although the difference is not statistically significant, compliance with the clarithromycin regime may be better.
Wharton JR, Wilson PL, Kincannon JM. Arch Dermatol 1998; 134: 671–2.
Three patients treated with a single 1 g dose of clarithromycin showed no sign of residual disease at 2 weeks.
Seville RH, Somerville A. Br J Dermatol 1970; 82: 502–6.
Twenty patients were treated with erythromycin 250 mg four times daily for 7 days. Nearly all cases with involvement of the axillae and groins, but only about two-thirds of toe web infections, were cured.
Turk BG, Turkmen M, Aytimur D. J Am Acad Dermatol 2011; 65: 1230–1.
This laboratory-based study examined antibiotic susceptibility in C. minutissimum isolates. Interestingly, it demonstrated high levels of antibiotic resistance to erythromycin and high levels of susceptibility to fusidic acid and to amoxicillin clavulanate.
Treatment of Skin Disease Comprehensive Therapeutic Strategies 4e
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Fusidic acid cream
Miconazole cream
Clotrimazole cream
Clindamycin lotion or solution
Whitfield’s ointment
Single dose clarithromycin
Erythromycin
