Eritrasma 2012

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

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ERYTHRASMA

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

dr. A. Rohayati Darma Mufti

infection of the skin characterized by well-difened but

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

2. The widespread form is found more frequently in the

subtropical and tropical areas

4. Men and women are equally affected; the crural

Invade the upper third of the stratum corneum

Hyperkeratotic and likely keratolytic processes

cornified cells and

Invade intracellular spaces

Stratum corneum is thickened

Lichenification and hyperpigmentation

Pseudomonas aeruginosa webspace

lesion are darker (hyperemia

erythema with areas of

atrophy and scale on the right

type): Hyperkeratotic and macerated (hydration of the

Tinea Pedis (interdigital type)

Most: between fourth and fifth toes

Groins and thighs, may extend to buttocks

+ (septated hyphae and spora) Dermatophytes can be isolated

+ (septated hyphae and spora)

Dermatophytes can be isolated Malassezia furfur

peroxide. Medicated powders. Topical antiseptic alcohol gels:

2. Topical Therapy: Preferable.

Clarithromycin: 1 gram single dose

Tetracylin: 250 mg for 7 days

COMPLICATION & PROGNOSIS

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