Skip to main content

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.

This is a preview of subscription content, access via your institution.

Fig. 1
Table I
Table II
Table III

References

  1. Sarkany I, Taplin D, Blank H. The etiology and treatment of erythrasma. J Invest Dermatol 1961; 37: 282–90

    Google Scholar 

  2. Sindhuphak W, MacDonald E, Smith EB. Erythrasma. Overlooked or misdiagnosed? Int J Dermatol 1985; 24: 95–6

    PubMed  Article  CAS  Google Scholar 

  3. Tachibana DK. Microbiology of the foot. Annu Rev Microbiol 1976; 30: 351–61

    PubMed  Article  CAS  Google Scholar 

  4. Hodson SB, Henslee TM, Tachibana DK, et al. Interdigital erythrasma. Part 1: a review of the literature. J Am Podiatr Med Assoc 1988; 78: 551–8

    PubMed  CAS  Google Scholar 

  5. Temple DE, Boardman CR. The incidence of erythrasma of the toe webs. Arch Dermatol 1962; 82: 518–9

    Article  Google Scholar 

  6. Noble WC. Skin bacteriology and the role of Staphylococcus aureus in infection. Br J Dermatol 1998; 139: 9–12

    PubMed  Article  Google Scholar 

  7. Henslee TM, Tanaka TJ, Hodson SB, et al. Interdigital erythrasma. Part 2: an incidence study. J Am Podiat Med Assoc 1988; 78: 559–61

    CAS  Google Scholar 

  8. O’Dell ML. Skin and wound infections; an overview. Am Fam Physician 1998; 57: 2424–32

    PubMed  Google Scholar 

  9. Somerville DA, Lancaster-Smith M. The aerobic cutaneous microflora of diabeticsubjects. Br J Dermatol 1973; 89: 395–9

    PubMed  Article  CAS  Google Scholar 

  10. Allen S, Christmas TI, McKinney W, et al. The Auckland skin clinic tinea pedis and erythrasma study. N Z Med J 1990; 103: 391–3

    PubMed  CAS  Google Scholar 

  11. Svejgaard E, Christophersen J, Jelsdorf HM. Tenia pedis and erythrasma in Danish recruits. J Am Acad Dermatol 1986; 14: 993–9

    PubMed  Article  CAS  Google Scholar 

  12. Montes LF, Dobson H, Dodge BG, et al. Erythrasma and diabetes mellitus. Arch Dermatol 1969; 99: 674–8

    PubMed  Article  CAS  Google Scholar 

  13. Smith LE, Henrichs D, McCullah RD. Prospective studies on the etiology and treatment of pruritus ani. Dis Colon Rectum 1982; 25: 358–63

    PubMed  Article  CAS  Google Scholar 

  14. Bowyer A, McColl I. Erythrasma and pruritus ani. Acta Dermatoverner (Stockholm) 1971; 51: 444–7

    CAS  Google Scholar 

  15. Mattox TF, Rutgers J, Yoshimori RN, et al. Nonfluorescent erythrasma of the vulva. Obstet Gynecol 1993; 81: 862–4

    PubMed  CAS  Google Scholar 

  16. Berg SA, Gorea A, Stadler J, et al. Recurrent breast abscesses caused by Corynebacterium minutissimum. J Clin Microbiol 1984; 20: 1219–20

    Google Scholar 

  17. Golledge CL, Phillips G. Corynebacterium minutissimum infection. J Infect 1991; 23: 73–6

    PubMed  Article  CAS  Google Scholar 

  18. Rupp ME, Stiles KG, Tarantolo S, et al. Central venous catheter related Corynebacterium minutissimum bacteremia. Infect Control Hosp Epidemiol 1998; 19: 786–9

    PubMed  Article  CAS  Google Scholar 

  19. Bandera A, Gori A, Rossi MC, et al. A case of costochondral abscess due to Corynebacterium minutissimum in an HIV infected patient. J Infect 2000; 41: 103–5

    PubMed  Article  CAS  Google Scholar 

  20. Kingerly FAJ. Imitators of the athlete’s foot. JAMA 1965; 193: 95–8

    Article  Google Scholar 

  21. Asawanonda P, Taylor CR. Wood’s light in dermatology. Int J Dermatol 1999; 38: 801–7

    PubMed  Article  CAS  Google Scholar 

  22. Padilha-Goncalves A. A single method to stain Malassezia furfur and Corynebacterium minutissimum in scales. Rev Inst Med Trop Sao Paulo 1996; 38: 299–302

    PubMed  Article  CAS  Google Scholar 

  23. Montes LF, Black SH. The fine structure of diphtheroids of erythrasma. J Invest Dermatol 1967; 48: 342–6

    PubMed  CAS  Google Scholar 

  24. Cohen SN, Nickolai D. Simple medium for pigmented production of the erythrasma diphtheroid. Appl Microbiol 1969; 17: 479–83

    PubMed  CAS  Google Scholar 

  25. Somerville DA, Noble WC, White PM, et al. Sodium fusidate in the treatment of erythrasma. Br J Dermatol 1971; 85: 450–3

    PubMed  Article  CAS  Google Scholar 

  26. Bowyer A, McColl I. The role of erythrasma in pruritus ani. Lancet 1966; 10: 572–3

    Article  Google Scholar 

  27. Gilbert DN, Moellering RC, Sande MA, et al. The Sanford guide to antimicrobial therapy. In: Gilbert DN, Moellering RC, Sande MA, et al. The Sanford guide to antimicrobial therapy 2001. Hyde Park (VT): Antimicrobial Therapy, Inc., 2001, 37

    Google Scholar 

  28. Petit JH. Treatment of superficial fungal infections of the skin. Drugs 1975; 10: 130–42

    Article  Google Scholar 

  29. Wilkinson JD. Fusidic acid in dermatology. Br J Dermatol 1998; 139: S37–40

    Article  Google Scholar 

  30. Wharton JR, Wilson PL, Kincannon JM. Erythrasma treated with single dose clarithromycin. Arch Dermatol 1998; 134: 671–2

    PubMed  Article  CAS  Google Scholar 

  31. Cochran RJ, Rosen T, Landers T. Topical treatment for erythrasma. Int J Dermatol 1981; 20: 562–4

    PubMed  Article  CAS  Google Scholar 

  32. Sarkany I, Taplin D, Blank H. Erythrasma-common bacterial infection of the skin. JAMA 1961; 177: 120–2

    Article  Google Scholar 

  33. Terezakis N. How I treat erythrasma. Postgrad Med 1979; 42: 201–3

    Google Scholar 

  34. Resh W, Stroughton R. Topically applied antibiotics in acne vulgaris. Arch Dermatol 1976; 112: 182–7

    PubMed  Article  CAS  Google Scholar 

  35. Rosen T, Waisman M. Topically administered clindamycin in the treatment of acne vulgaris and other dermatological disorders. Pharmacotherapy 1981; 1: 201–5

    PubMed  CAS  Google Scholar 

  36. Seville RH, Somerville DA. The treatment of erythrasma in a hospital for the mentally subnormal. Br J Dermatol 1970; 28: 502–6

    Article  Google Scholar 

  37. Clayton YV, Connor BL. Comparison of clotrimazole cream, Whitfield’s ointment and nystatin ointment for the topical treatment of ringworm infections, pityriasis versicolor, erythrasma and candidiasis. Br J Dermatol 1973; 89: 297–303

    PubMed  Article  CAS  Google Scholar 

  38. MacMillan AL, Sarkany I. Specific topical therapy of erythrasma. Br J Dermatol 1970; 82: 507–9

    PubMed  Article  CAS  Google Scholar 

  39. Dodge BG, Knowles WR, McBride ME, et al. Treatment of erythrasma with an antibacterial soap. Arch Derm 1968; 97: 549–52

    Article  Google Scholar 

  40. Pettit JHS. Treatment of superficial fungal infections of the skin. Drugs 10; 1975: 130–142

    PubMed  Article  CAS  Google Scholar 

  41. Lackner TE, Clissold SP. Bifonazole. A review of its antimicrobial activity and therapeutic use in superficial mycoses. Drugs 1989; 38: 204–25

    PubMed  Article  CAS  Google Scholar 

Download references

Acknowledgements

No sources of funding were used in the preparation of this manuscript. No conflicts of interest exist which may be relevant to the contents of the manuscript.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Mack R. Holdiness.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Holdiness, M.R. Management of Cutaneous Erythrasma. Drugs 62, 1131–1141 (2002). https://doi.org/10.2165/00003495-200262080-00002

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00003495-200262080-00002

Keywords

  • Erythromycin
  • Clarithromycin
  • Infective Endocarditis
  • Topical Therapy
  • Dermatophytosis