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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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.

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