ERYTHRASMA

AMMAR ABDURRAHMAN HASYIM C111 08 302 NURJANNAH S. TOEKAN C111 08 286

Advisor:

dr. A. Rohayati Darma Mufti

Supervisor:

dr. Sitti Nur Rahmah, Sp.KK. DERMATOVENEROLOGY DEPARTMENT MEDICAL FACULTY HASANUDDIN UNIVERSITY
MAKASSAR, AUGUST 2012

INTRODUCTION
Definition: Erythrasma is a common superficial bacterial

infection of the skin characterized by well-difened but

irregular reddish brown patches, occuring in the

intertriginous areas, or by fissuring and white maceration in the toe clefts.

EPIDEMIOLOGY
1. The incidence of erythrasma is reported to be around

4%

2. The widespread form is found more frequently in the

subtropical and tropical areas

3. The incidence of erythrasma increases with age and higher in black people

4. Men and women are equally affected; the crural

form is more common in men and the interdigital form is more common in women (83% of 24 patients).

ETIOLOGY

The incriminated organism is Corynebacterium minutissimum, which usually is present as a normal human skin inhabitant.

Prediposing Factors: Humid cutaneous microclimate, warm and/or humid climate or season; occlusive clothing/shoes; obesity; diabetes mellitus; hiperhydrosis; poor hygiene; and immunocompromised states.

PATHOGENESIS
Corynebacterium minutissimum dispersed over the skin surface
In heat and humidity conditions: these organisms proliferate

Invade the upper third of the stratum corneum

Hyperkeratotic and likely keratolytic processes

Penetrating superficial

cornified cells and

keratinized cells

Invade intracellular spaces

Stratum corneum is thickened

Lichenification and hyperpigmentation

ERYTHRASMA

CLINICAL MANIFESTATION

Figure 1. A. Sharply marginated, red patch in the axilla. B. This macerated interdigital web-space.

DIAGNOSIS
1. Anamnesis :

Commonly asymptomatic
Duration: weeks to months to years
Frequently misdiagnosed as tinea cruris or pedis

DIAGNOSIS
2. Physical examination:
Site of predilection Toe webspaces Inguinal folds (inner thigs) Axilla Skin Lesion Patches, sharply marginated, macerated, eroded, fissured, red or brownish red. Pruriticexcoriation, lichenification

Groin
Intergluteal Inframammary

DIAGNOSIS
3.

Laboratory examinations:
a.

Wood Lamp: Characteristic coral-red fluorescence (attributed to coproporphyrin III). May not be present if patient has bathed recently.

Figure 2. A. Coral-red fluoresence of interdigital lesion B. Coral-red fluoresence of inguinal (crural) lesion

DIAGNOSIS
b.

Direct Microscopy: Negative for fungal forms on KOH preparation of skin scraping.

c.

Bacterial Culture:

Heavy growth of Corynebacterium. Rules out Staphylococcus aureus, group A or group B Streptococcus, and Candida infection.

Pseudomonas aeruginosa webspace

infection (feet) is also present.

Figure 4. KOH preparation of skin scraping show fine filaments of Corynebacterium minutissimum.

DIFFERENTIAL DIAGNOSIS
1. Pityriasis versicolor

Figure 5.
A. Pityriasis versicolor: These

lesion are darker (hyperemia

secondary inflammatory response and increased
A

melanin).
B. Spaghetti and meatballs

appearence of Malassezia in

KOH preparation.

DIFFERENTIAL DIAGNOSIS
Figure 6.
2. Tinea Cruris: Blotchy

2.

erythema with areas of

atrophy and scale on the right

medial upper thigh boerdering the inguinal area.
3. Tinea Pedis (interdigital

3.

type): Hyperkeratotic and macerated (hydration of the

stratum corneum).

Tinea Pedis (interdigital type)

Tinea Cruris

Pityriasis Versicolor

Site of Predilection

Most: between fourth and fifth toes

Groins and thighs, may extend to buttocks

Upper trunk, upper arms, neck, abdomen, axillae, groins, thighs, genitalia Blue-green (yellowish white or copper-orange) Spagetthi and meatballs apperance

Wood Lamp

Yellow-green

Yellow-green

Direct microscopy

+ (septated hyphae and spora) Dermatophytes can be isolated

+ (septated hyphae and spora)

Culture

Dermatophytes can be isolated Malassezia furfur

TREATMENT
1. Prevention/Prophylaxis:
isopropyl, ethanol.

Wash

with

benzoyl

peroxide. Medicated powders. Topical antiseptic alcohol gels:

2. Topical Therapy: Preferable.

Benzoyl peroxide (2,5 %) gel daily, after showering, for 7 days Topical erythromycin or clindamycin solution twice daily for 7 days Sodium fusidate ointment, mupirocin ointment or cream Benzoic acid cream (6%) and salicylic acid cream (3%) Topical antifungal agents: clotrimazole, miconazole, econazole, or ketoconazole (2%)

TREATMENT
3. Systemic Antibiotic Therapy:

Erythromycin:
Children: 30-50 mg/kgBW/day 7-10 days Adult: 4 x 250 mg/day 2-3 weeks

Clarithromycin: 1 gram single dose

Tetracylin: 250 mg for 7 days

COMPLICATION & PROGNOSIS

Complication

Prognosis

Fatal septicemia
Infective endocarditis

Excellent
The condition tends to recur if the

Postsurgical wound
infection

predisposing factors
are not eliminated