What are the treatment options for erythrasma?

Answer

Infection may be treated with topical and/or oral agents. First-line therapy is topical erythromycin or clindamycin, or fusidic acid cream or miconazole cream. However, fusidic acid is not available in the United States, so topical treatment with the other agents mentioned is the standard of care in the United States. In 2017, mupirocin 2% ointment monotherapy was used on a series of 9 male patients twice daily for 2-4 weeks, with complete resolution of their signs and symptoms.^[34]Other topical treatments have been tried more recently and include ozonated olive oil every 12 hours for 10 days, with a cure rate of 100%.^[35]

Oral erythromycin is usually effective and is a good second-line therapy, as is single-dose clarithromycin or amoxicillin-clavulanate, for systemic treatment.^[36]

C minutissimum is generally susceptible to penicillins, first-generation cephalosporins, erythromycin, clindamycin, ciprofloxacin, tetracycline, and vancomycin. However, multiresistant strains have been isolated.^{[37, 38, 39, 40]}In a susceptibility study of 40 patients, several antibiotics were tested, including penicillin G, ampicillin, cefaclor, amoxicillin-clavulanate, ampicillin-sulbactam, tetracycline, erythromycin, ofloxacin, fusidic acid, levofloxacin, and azithromycin. The study revealed statistically significant resistance to erythromycin, azithromycin, penicillin, and ampicillin. Significant susceptibility was statistically found to amoxicillin-clavulanate, cefaclor, and fusidic acid.^[36]

In a large double-blind, placebo-controlled, randomized trial, 151 patients older than 18 years were randomized into five groups and were given either erythromycin, single-dose clarithromycin, topical fusidic acid, placebo cream, or placebo tablets. Fusidic acid cream was significantly more effective than other therapies. Additionally, the group that received clarithromycin did better at 48 hours than did the group that received erythromycin. However, there was no statistical difference on day 7 and day 14.^[41]

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Dellion S, Morel P, Vignon-Pennamen D, Felten A. Erythrasma owing to an unusual pathogen. Arch Dermatol. 1996 Jun. 132(6):716-7. [Medline].
Yasuma A, Ochiai T, Azuma M, Nishiyama H, Kikuchi K, Kondo M, et al. Exogenous coproporphyrin III production by Corynebacterium aurimucosum and Microbacterium oxydans in erythrasma lesions. J Med Microbiol. 2011 Jul. 60 (Pt 7):1038-42. [Medline].
Penton PK, Tyagi E, Humrighouse BW, McQuiston JR. Complete Genome Sequence of Corynebacterium minutissimum, an Opportunistic Pathogen and the Causative Agent of Erythrasma. Genome Announc. 2015 Mar 19. 3 (2):[Medline].
Sarkany I, Taplin D, Blank H. Incidence and bacteriology of erythrasma. Arch Dermatol. 1962 May. 85:578-82. [Medline].
Inci M, Serarslan G, Ozer B, et al. The prevalence of interdigital erythrasma in southern region of Turkey. J Eur Acad Dermatol Venereol. 2011 Oct 7. [Medline].
Halvaee S, Daie Ghazvini R, Hashemi SJ, Zibafar E, Yekaninejad S, Geramishoar M, et al. Investigation of Intertriginous Mycotic and Pseudomycotic (Erythrasma) Infections and Their Causative Agents with Emphasize on Clinical Presentations. Iran J Public Health. 2018 Sep. 47 (9):1406-1412. [Medline].
Rao AG, Karanam A, Farheen SS. Erythrasma of Palm: Presentation at the Rare Site. Indian Dermatol Online J. 2019 May-Jun. 10 (3):356-357. [Medline].
Morales-Trujillo ML, Arenas R, Arroyo S. [Interdigital erythrasma: clinical, epidemiologic, and microbiologic findings]. Actas Dermosifiliogr. 2008 Jul-Aug. 99(6):469-73. [Medline].
Pinto M, Hundi GK, Bhat RM, Bala NK, Dandekeri S, Martis J, et al. Clinical and epidemiological features of coryneform skin infections at a tertiary hospital. Indian Dermatol Online J. 2016 May-Jun. 7 (3):168-73. [Medline].
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 Jul. 41(1):103-5. [Medline].
Van Bosterhaut B, Cuvelier R, Serruys E, Pouthier F, Wauters G. Three cases of opportunistic infection caused by propionic acid producing Corynebacterium minutissimum. Eur J Clin Microbiol Infect Dis. 1992 Jul. 11(7):628-31. [Medline].
Fernandez Giron F, Saavedra Martin JM, Benítez Sanchez M, Fernandez Mora F, Rodriguez Gomez E. Corynebacterium minutissimum peritonitis in a CAPD patient. Perit Dial Int. 1998 May-Jun. 18(3):345-6. [Medline].
Aperis G, Moyssakis I. Corynebacterium minutissimum endocarditis: a case report and review. J Infect. 2007 Feb. 54(2):e79-81. [Medline].
Herschorn BJ, Brucker AJ. Embolic retinopathy due to Corynebacterium minutissimum endocarditis. Br J Ophthalmol. 1985 Jan. 69(1):29-31. [Medline].
Ahmad NM, Ahmad KM. Corynebacterium minutissimum pyelonephritis with associated bacteraemia: a case report and review of literature. J Infect. 2005 Dec. 51(5):e299-303. [Medline].
Craig J, Grigor W, Doyle B, Arnold D. Pyelonephritis caused by Corynebacterium minutissimum. Pediatr Infect Dis J. 1994 Dec. 13(12):1151-2. [Medline].
Granok AB, Benjamin P, Garrett LS. Corynebacterium minutissimum bacteremia in an immunocompetent host with cellulitis. Clin Infect Dis. 2002 Aug 15. 35(4):e40-2. [Medline].
Arsan AK, Sizmaz S, Ozkan SB, Duman S. Corynebacterium minutissimum endophthalmitis: management with antibiotic irrigation of the capsular bag. Int Ophthalmol. 1995-1996. 19(5):313-6. [Medline].
Santos-Juanes J, Galache C, Martinez-Cordero A, et al. Cutaneous granulomas caused by corynebacterium minutissimum in an HIV-infected man. J Eur Acad Dermatol Venereol. 2002 Nov. 16(6):643-5. [Medline].
Dalal A, Likhi R. Corynebacterium minutissimum bacteremia and meningitis: a case report and review of literature. J Infect. 2008 Jan. 56(1):77-9. [Medline].
Shin JY, Lee WK, Seo YH, Park YS. Postoperative Abdominal Infection Caused by Corynebacterium minutissimum. Infect Chemother. 2014 Dec. 46 (4):261-3. [Medline].
Groves JB, Freeman AM. Erythrasma. StatPearls [Internet]. 2020 Jan. [Medline]. [Full Text].
Blaise G, Nikkels AF, Hermanns-Lê T, Nikkels-Tassoudji N, Piérard GE. Corynebacterium-associated skin infections. Int J Dermatol. 2008 Sep. 47 (9):884-90. [Medline].
Aste N, Pau M, Aste N. Pityriasis versicolor on the groin mimicking erythrasma. Mycoses. 2004 Jun. 47(5-6):249-51. [Medline].
Karakatsanis G, Vakirlis E, Kastoridou C, Devliotou-Panagiotidou D. Coexistence of pityriasis versicolor and erythrasma. Mycoses. 2004 Aug. 47(7):343-5. [Medline].
Bowyer A, McColl I. Erythrasma and pruritus ani. Acta Derm Venereol. 1971. 51(6):444-7. [Medline].
Marinella MA. Erythrasma and seborrheic dermatitis of the groin. Am Fam Physician. 1995 Nov 15. 52(7):2012. [Medline].
Rho NK, Kim BJ. A corynebacterial triad: Prevalence of erythrasma and trichomycosis axillaris in soldiers with pitted keratolysis. J Am Acad Dermatol. 2008 Feb. 58(2 Suppl):S57-8. [Medline].
Finch J. Case of trichomycosis axillaris and erythrasma. J Drugs Dermatol. 2011 Dec. 10(12):1472-3. [Medline].
Polat M, İlhan MN. The prevalence of interdigital erythrasma: a prospective study from an outpatient clinic in Turkey. J Am Podiatr Med Assoc. 2015 Mar. 105 (2):121-4. [Medline].
Mattox TF, Rutgers J, Yoshimori RN, Bhatia NN. Nonfluorescent erythrasma of the vulva. Obstet Gynecol. 1993 May. 81(5 (Pt 2)):862-4. [Medline].
Yasuma A, Ochiai T, Azuma M, et al. Exogenous coproporphyrin III production by Corynebacterium aurimucosum and Microbacterium oxydans in erythrasma lesions. J Med Microbiol. 2011 Jul. 60:1038-42. [Medline].
Montes LF, Black SH, McBride ME. Bacterial invasion of the stratum corneum in erythrasma. I. Ultrastructural evidence for a keratolytic action experted by Corynebacterium minutissimum. J Invest Dermatol. 1967 Nov. 49(5):474-85. [Medline].
Greywal T, Cohen PR. Erythrasma: A report of nine men successfully managed with mupirocin 2% ointment monotherapy. Dermatol Online J. 2017 May 15. 23 (5):[Medline].
Ramírez-Hobak L, Moreno-Coutiño G, Arenas-Guzmán R, Gorzelewski A, Fernández-Martínez R. [Treatment of interdigital foot Erythrasma with ozonated olive oil]. Rev Med Inst Mex Seguro Soc. 2016 Jul-Aug. 54 (4):458-61. [Medline].
Turk BG, Turkmen M, Aytimur D. Antibiotic susceptibility of Corynebacterium minutissimum isolated from lesions of Turkish patients with erythrasma. J Am Acad Dermatol. 2011 Dec. 65(6):1230-1. [Medline].
Clayton YM, 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 Sep. 89(3):297-303. [Medline].
Hamann K, Thorn P. Systemic or local treatment of erythrasma? A comparison between erythromycin tablets and Fucidin cream in general practice. Scand J Prim Health Care. 1991 Mar. 9(1):35-9. [Medline].
Holdiness MR. Management of cutaneous erythrasma. Drugs. 2002. 62(8):1131-41. [Medline].
Wharton JR, Wilson PL, Kincannon JM. Erythrasma treated with single-dose clarithromycin. Arch Dermatol. 1998 Jun. 134(6):671-2. [Medline].
Avci O, Tanyildizi T, Kusku E. A comparison between the effectiveness of erythromycin, single-dose clarithromycin and topical fusidic acid in the treatment of erythrasma. J Dermatolog Treat. 2011 Sep 18. [Medline].
Darras-Vercambre S, Carpentier O, Vincent P, Bonnevalle A, Thomas P. Photodynamic action of red light for treatment of erythrasma: preliminary results. Photodermatol Photoimmunol Photomed. 2006 Jun. 22(3):153-6. [Medline].

Media Gallery

Lichenification and hyperpigmentation are common. The skin occasionally has a wrinkled appearance with scales. KOH test results are negative. Courtesy of Michael Bryan, MD.
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.

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Author

Abdul-Ghani Kibbi, MD, FACP Professor and Chair, Department of Dermatology, American University of Beirut Medical Center, Lebanon

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD.

Additional Contributors

Robin Travers, MD Assistant Professor of Medicine (Dermatology), Dartmouth University School of Medicine; Staff Dermatologist, New England Baptist Hospital; Private Practice, SkinCare Physicians

Robin Travers, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Informatics Association, Massachusetts Medical Society, Women's Dermatologic Society, Medical Dermatology Society

Disclosure: Nothing to disclose.

Fady G Haddad, MD Specialist Dermatologist, Dubai Healthcare City, UAE

Fady G Haddad, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Ruba Faik Bahhady, MD Senior Specialist, Department of Dermatology, American University of Beirut Medical Center

Disclosure: Nothing to disclose.

Maria S Bou Sleiman, MD Resident Physician, Department of Dermatology, American University of Beirut Medical Center

Disclosure: Nothing to disclose.

Acknowledgements

Zenus Saleh, MD Staff Physician, Department of Dermatology, American University of Beirut Medical Center

Zenus Saleh, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

What are the treatment options for erythrasma?

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