74 Erythrasma Melissa C. Barkham Evidence Levels: A Double-blind study B Clinical trial ≥ 20 subjects C Clinical trial < 20 subjects D Series ≥ 5 subjects E Anecdotal case reports In its most typical form, erythrasma is characterized by well-defined reddish-brown flexural plaques which show fine scaling and no tendency to central clearing. It may also present with maceration of the toe webs. The responsible organism, Corynebacterium minutissimum, is an inhabitant of normal human skin. Factors that predispose to clinically apparent infection include diabetes mellitus, obesity, old age, and a humid environment. Management strategy Erythrasma is often a trivial infection, but therapy may be requested because of the cosmetic appearance or because of pruritus. Co-infection with dermatophyte fungi or Candida albicans is common and may influence the choice of treatment. Fusidic acid cream is the topical treatment of choice where no concomitant yeast or fungal infection is found. It is both effective and well tolerated. Topical imidazoles (miconazole, clotrimazole) are well tolerated and also effective against concomitant fungal or yeast infection. Whitfield’s ointment (benzoic acid compound) is effective but is less well tolerated than other topical treatments. When the disease is extensive or when compliance with topical therapy is unlikely, oral antibiotics such as single dose clarithromycin or oral erythromycin should be considered. A combination of oral and topical treatment may be required for stubborn infections, particularly of the toe webs. Specific investigations Examination under Wood’s light Potassium hydroxide preparation of skin scrapings Fasting serum glucose Rapid confirmation of the diagnosis is achieved by examination of the skin under Wood’s (long-wave ultraviolet) light. The characteristic coral-red fluorescence observed is due to the production of coproporphyrin III by the organism. Fluorescence may not be seen if the patient has bathed immediately prior to examination. Culture is unreliable because the organism does not always grow satisfactorily. Microscopy of skin scrapings is performed to seek evidence of concomitant infection, such as the presence of fungal hyphae or yeasts. Consider underlying diabetes mellitus if erythrasma is severe or recurrent. Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: Cat scratch disease Mucoceles Tinea capitis Herpes genitalis Necrolytic migratory erythema Nevoid basal cell carcinoma syndrome Stay updated, free articles. Join our Telegram channel Join Tags: Treatment of Skin Disease Comprehensive Therapeutic Strategies Aug 7, 2016 | Posted by admin in Dermatology | Comments Off on Erythrasma Full access? Get Clinical Tree
74 Erythrasma Melissa C. Barkham Evidence Levels: A Double-blind study B Clinical trial ≥ 20 subjects C Clinical trial < 20 subjects D Series ≥ 5 subjects E Anecdotal case reports In its most typical form, erythrasma is characterized by well-defined reddish-brown flexural plaques which show fine scaling and no tendency to central clearing. It may also present with maceration of the toe webs. The responsible organism, Corynebacterium minutissimum, is an inhabitant of normal human skin. Factors that predispose to clinically apparent infection include diabetes mellitus, obesity, old age, and a humid environment. Management strategy Erythrasma is often a trivial infection, but therapy may be requested because of the cosmetic appearance or because of pruritus. Co-infection with dermatophyte fungi or Candida albicans is common and may influence the choice of treatment. Fusidic acid cream is the topical treatment of choice where no concomitant yeast or fungal infection is found. It is both effective and well tolerated. Topical imidazoles (miconazole, clotrimazole) are well tolerated and also effective against concomitant fungal or yeast infection. Whitfield’s ointment (benzoic acid compound) is effective but is less well tolerated than other topical treatments. When the disease is extensive or when compliance with topical therapy is unlikely, oral antibiotics such as single dose clarithromycin or oral erythromycin should be considered. A combination of oral and topical treatment may be required for stubborn infections, particularly of the toe webs. Specific investigations Examination under Wood’s light Potassium hydroxide preparation of skin scrapings Fasting serum glucose Rapid confirmation of the diagnosis is achieved by examination of the skin under Wood’s (long-wave ultraviolet) light. The characteristic coral-red fluorescence observed is due to the production of coproporphyrin III by the organism. Fluorescence may not be seen if the patient has bathed immediately prior to examination. Culture is unreliable because the organism does not always grow satisfactorily. Microscopy of skin scrapings is performed to seek evidence of concomitant infection, such as the presence of fungal hyphae or yeasts. Consider underlying diabetes mellitus if erythrasma is severe or recurrent. Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: Cat scratch disease Mucoceles Tinea capitis Herpes genitalis Necrolytic migratory erythema Nevoid basal cell carcinoma syndrome Stay updated, free articles. Join our Telegram channel Join
