Management of Cutaneous Erythrasma

Abstract

Corynebacterium minutissimum is the bacteria that leads to cutaneous eruptions of erythrasma and is the most common cause of interdigital foot infections. It is found mostly in occluded intertriginous areas such as the axillae, inframammary areas, interspaces of the toes, intergluteal and crural folds, and is more common in individuals with diabetes mellitus than other clinical patients. This organism can be isolated from a cutaneous site along with a concurrent dermatophyte or Candida albicans infection. The differential diagnosis of erythrasma includes psoriasis, dermatophytosis, candidiasis and intertrigo, and methods for differentiating include Wood's light examination and bacterial and mycological cultures. Erythromycin 250mg four times daily for 14 days is the treatment of choice and other antibacterials include tetracycline and chloramphenicol; however, the use of chloramphenicol is limited by bone marrow suppression potentially leading to neutropenia, agranulocytosis and aplastic anaemia. Further studies are needed but clarithromycin may be an additional drug for use in the future. Where there is therapeutic failure or intertriginous involvement, topical solutions such as clindamycin, Whitfield's ointment, sodium fusidate ointment and antibacterial soaps may be required for both treatment and prophylaxis. Limited studies on the efficacy of these medications exist, however, systemic erythromycin demonstrates cure rates as high as 100%. Compared with tetracyclines, systemic erythromycin has greater efficacy in patients with involvement of the axillae and groin, and similar efficacy for interdigital infections. Whitfield's ointment has equal efficacy to systemic erythromycin in the axillae and groin, but shows greater efficacy in the interdigital areas and is comparable with 2% sodium fusidate ointment for treatment of all areas. Adverse drug effects and potential drug interactions need to be considered. No cost-effectiveness data are available but there are limited data on cost-related treatment issues. A guideline is proposed for the detection, evaluation, treatment and prophylaxis of this cutaneous eruption.

Perianal Skin Conditions

“…Topical antibiotics such as fusidic acid or clindamycin suffi ce in limited lesions. More extensive involvement responds rapidly to oral erythromycin [ 81 ].…”

Challenges in anti-infective therapy for skin conditions: part 1

“…Candidiasis can be differentiated from tinea cruris by its irregular border with satellite lesions and scrotal involvement (which often appears bright red and shiny). Cutaneous erythrasma, a cutaneous bacterial infection caused by Corynebacterium minutissimum, can easily mimic tinea cruris as 30% of patients with interdigital erythrasma have been found to have a coexisting dermatophyte or C. albicans infection, usually noted in the third and fourth interspaces [55].…”

“…The latter are used solely for symptomatic care. Tinea corporis and tinea cruris can be effectively treated systemically by fluconazole 50-100 mg/day or 150 mg once weekly for 2-3 weeks, by itraconazole 100 mg/day for 2 weeks or 200 mg/day for 7 days and by terbinafine 250 mg/day for 1-2 weeks [55][56][57]. In one smaller study that examined fluconazole at a dose of 150 mg once-weekly for tinea corporis or tinea cruris, the authors found an overall cure rate of 95% and noted that 70% of patients required two doses for cure, 20% of patients required three doses for cure and 10% required four doses [56].…”

“…In one smaller study that examined fluconazole at a dose of 150 mg once-weekly for tinea corporis or tinea cruris, the authors found an overall cure rate of 95% and noted that 70% of patients required two doses for cure, 20% of patients required three doses for cure and 10% required four doses [56]. There were no adverse effects or significant laboratory abnormalities [55]. A recent double-blind, parallel-group study compared fluconazole 150 mg once weekly with griseofulvin 500 mg/day, over a course of 4-6 weeks for each [57].…”

A comparison between the effectiveness of erythromycin, single-dose clarithromycin and topical fusidic acid in the treatment of erythrasma

“…It is characterized by erythematous, brown, scaly patches and maceration, and exhibits coral-red fluorescence under Wood's light (5)(6)(7)(8). There is no standard method of treatment for erythrasma, and a variety of oral, topical and adjunctive therapy models are used (9). In this study, our aim was to compare the effectiveness of the treatments with erythromycin, single-dose clarithromycin and topical fusidic acid with the double-blind, randomized, placebo-controlled method in patients with erythrasma.…”