You are in: eMedicine Specialties > Dermatology > BACTERIAL INFECTIONS ErythrasmaArticle Last Updated: Feb 27, 2007AUTHOR AND EDITOR INFORMATIONSection 1 of 11
  Author: Abdul-Ghani Kibbi, MD, Chairman and Professor, Department of Dermatology, American University of Beirut Medical Center, Lebanon Coauthor(s): Zenus Saleh, MD, Staff Physician, Department of Dermatology, American University of Beirut Medical Center; Fadi Haddad, MD, Specialist, Divisions of Dermatology, Tawam Hospital, United Arab Emirates Editors: Robin Travers, MD, Professor, Department of Dermatology, Boston University School of Medicine; Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA; Jeffrey Meffert, MD, Assistant Clinical Professor of Dermatology, University of Texas Health Science Center-San Antonio; Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University; Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center Author and Editor Disclosure Synonyms and related keywords: Corynebacterium minutissimum, C minutissimum, Corynebacterium afermentans, C afermentans INTRODUCTIONSection 2 of 11
  BackgroundErythrasma is a chronic superficial infection of the intertriginous areas of the skin. The incriminated organism is Corynebacterium minutissimum, which usually is present as a normal human skin inhabitant. In 1996, Corynebacterium afermentans was reported in one case. PathophysiologyCorynebacteria invade the upper one-third of the stratum corneum; under favorable conditions such as heat and humidity, these organisms proliferate. The stratum corneum is thickened. The organisms are seen in the intercellular spaces as well as within cells, dissolving keratin fibrils. The coral red fluorescence of scales seen under Wood light is secondary to the production of porphyrin by these diphtheroids. FrequencyInternationalThe incidence of erythrasma is reported to be around 4%. This infection is observed all over the world; the widespread form is found more frequently in the subtropical and tropical areas than in other parts of the world. Mortality/MorbidityErythrasma is usually a benign condition. However, it may become widespread and invasive in predisposed and immunocompromised individuals; this is very rare in immunocompetent hosts. In such individuals, this organism has caused infections other than erythrasma. These include abscess formation (3 cases), intravascular catheter–related infections (3 cases), primary bacteremia (3 cases), peritoneal catheter–related infections (2 cases), endocarditis (1 case), and pyelonephritis (1 case). RaceThe incidence is higher in black people. SexBoth sexes are equally affected; however, the crural form is more common in men. AgeThe incidence of erythrasma increases with age, but no age group is immune to the disease. The youngest patient reported to have this condition is a 1-year-old infant. CLINICALSection 3 of 11
History
Physical
Causes
DIFFERENTIALSSection 4 of 11
Acanthosis Nigricans Candidiasis, Cutaneous Contact Dermatitis, Allergic Contact Dermatitis, Irritant Intertrigo Psoriasis, Plaque Seborrheic Dermatitis Tinea Corporis Tinea Cruris Tinea Pedis
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| Drug Name | Erythromycin (E.E.S., E-Mycin, Ery-Tab) |
|---|---|
| Description | DOC that inhibits bacterial growth, possibly by blocking dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest. In children, age, weight, and severity of infection determine proper dosage. When bid dosing is desired, half-total daily dose may be taken q12h. For more severe infections, double the dose. |
| Adult Dose | 250 mg PO qid or 500 mg PO bid for 7-14 d 2-4% solution: Apply to affected area bid for 4-6 wk |
| Pediatric Dose | 30-50 mg/kg/d PO bid for 7-10 d 2-4% solution: Apply to affected area as in adults |
| Contraindications | Documented hypersensitivity; hepatic impairment |
| Interactions | Coadministration may increase toxicity of theophylline, digoxin, bromocriptine, alfentanil, cisapride, felodipine, ergotamine, midazolam, triazolam, methylprednisolone, carbamazepine, and cyclosporine; may potentiate anticoagulant effects of warfarin; coadministration with lovastatin and simvastatin increases risk of rhabdomyolysis; cimetidine may increase levels of erythromycin; arrhythmias and increases in QTc intervals occur with disopyramide; no interactions reported with topical dosage form |
| Pregnancy | B - Usually safe but benefits must outweigh the risks. |
| Precautions | Caution in liver disease; estolate formulation may cause cholestatic jaundice; GI adverse effects are common (give doses pc); discontinue use if nausea, vomiting, malaise, abdominal colic, or fever occur; 2-4% solution, discontinue if irritation or sensitivity occur |
| Drug Name | Clarithromycin (Biaxin) |
|---|---|
| Description | Inhibits bacterial growth, possibly by blocking dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest. |
| Adult Dose | 1 g PO once |
| Pediatric Dose | 15 mg/kg PO once |
| Contraindications | Documented hypersensitivity; coadministration of pimozide or cisapride |
| Interactions | Toxicity increases with coadministration of fluconazole, astemizole, and pimozide; clarithromycin effects decrease and GI adverse effects may increase with coadministration of rifabutin or rifampin; may increase toxicity of anticoagulants, cyclosporine, tacrolimus, digoxin, omeprazole, carbamazepine, ergot alkaloids, triazolam, HMG CoA-reductase inhibitors; cardiac arrhythmias may occur with coadministration of cisapride; plasma levels of certain benzodiazepines may increase, prolonging CNS depression; arrhythmias and increase in QTc intervals occur with disopyramide; coadministration with omeprazole may increase plasma levels of both agents |
| Pregnancy | C - Safety for use during pregnancy has not been established. |
| Precautions | Coadministration with ranitidine or bismuth citrate is not recommended with CrCl <25 mL/min; give half dose or increase dosing interval if CrCl <30 mL/min; diarrhea may be sign of pseudomembranous colitis; superinfections may occur with prolonged or repeated antibiotic therapies |
| Drug Name | Fusidic acid (Zeta) |
|---|---|
| Description | Topical antibacterial that inhibits bacterial protein synthesis, causing bacterial death. Use 2% cream. |
| Adult Dose | Apply to affected area bid for 2 wk |
| Pediatric Dose | Apply as in adults |
| Contraindications | Documented hypersensitivity |
| Interactions | None reported |
| Pregnancy | B - Usually safe but benefits must outweigh the risks. |
| Precautions | Discontinue if irritation or sensitivity occur |
| Drug Name | Miconazole (Femazole, Lotrimin, Monistat) |
|---|---|
| Description | Damages fungal cell wall membrane by inhibiting biosynthesis of ergosterol. Membrane permeability is increased causing nutrients to leak out, resulting in fungal-cell death. The lotion is preferred in intertriginous areas. If the cream is used, apply sparingly to avoid maceration effects. Use 2% cream. |
| Adult Dose | Apply to affected area bid for 2 wk |
| Pediatric Dose | Apply as in adults |
| Contraindications | Documented hypersensitivity |
| Interactions | None reported |
| Pregnancy | C - Safety for use during pregnancy has not been established. |
| Precautions | If sensitivity or chemical irritation occurs, discontinue use; use only externally; avoid contact with eyes |
| Drug Name | Benzoic acid 6%, salicylic acid 3% (Whitfield's ointment) |
|---|---|
| Description | Treats infection and inflammation associated with erythrasma. |
| Adult Dose | Apply to affected area bid for 4 wk |
| Pediatric Dose | Not established |
| Contraindications | Documented hypersensitivity |
| Interactions | None reported |
| Pregnancy | C - Safety for use during pregnancy has not been established. |
| Precautions | For external use only |
| Drug Name | Clindamycin (Cleocin) |
|---|---|
| Description | Has a bacteriostatic effect; it interferes with bacterial protein synthesis similarly to erythromycin and chloramphenicol by binding to 50S subunit of bacterial ribosome. |
| Adult Dose | Apply 2% aqueous solution tid for 1 wk |
| Pediatric Dose | Not established |
| Contraindications | Documented hypersensitivity |
| Interactions | Interacts with opiates and diphenoxylate plus atropine, resulting in slowing of peristalsis; may enhance action of neuromuscular blocking agents; coadministration with erythromycin leads to increased level of clindamycin |
| Pregnancy | D - Unsafe in pregnancy |
| Precautions | Allergic skin reactions, severe colitis, neutropenia, and polyarthritis |
| Drug Name | Tetracycline (Achromycin) |
|---|---|
| Description | Inhibits cell growth by inhibiting mRNA translation. Binds to 16S part of 30S ribosomal subunit and prevents amino-acyl tRNA from binding to A site of ribosome. Binding is reversible in nature. |
| Adult Dose | 250 mg qid for 14 d |
| Pediatric Dose | Not established |
| Contraindications | Documented hypersensitivity |
| Interactions | Interferes with bactericidal action of penicillins, renders oral contraceptives less effective, and potentiates effects of warfarin |
| Pregnancy | B - Usually safe but benefits must outweigh the risks. |
| Precautions | Esophagitis, allergic reactions, phototoxic reactions, renal toxicity, hemolytic anemia, pseudotumor cerebri, vestibular toxicity, and tooth discoloration |
| Media file 1: Lichenification and hyperpigmentation are common. The skin occasionally has a wrinkled appearance with scales. KOH test results are negative. Courtesy of Michael Bryan, MD. | |
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| Media file 2: Under Wood lamp examination, the porphyrins produced by the bacteria fluoresce with a coral pink color. A small focus is visible on this photo. If the patient recently has bathed, the pigment may be washed away. In suspicious cases, a repeat examination the following day may be necessary. Courtesy of Michael Bryan, MD. | |
 | View Full Size Image | Media type: Photo |
Article Last Updated: Feb 27, 2007
