Erythrasma

Published on 19/03/2015 by admin

Filed under Dermatology

Last modified 19/03/2015

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Erythrasma

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

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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.

Management strategy

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.