Topical Antibacterials

Several azole-group antifungal agents have sufficient antimicrobial activity to treat most cases of erythrasma. Clotrimazole, econazole, miconazole, oxiconazole, and tiocona-zole have all been demonstrated effective and each is available in cream base, which is the appropriate vehicle. Ointments cause maceration in intertriginous regions and gel or aerosol vehicles are inherently irritating in these tender areas. Medication should be applied in a thin layer BID for 10 to 14 days. Erythrasma often clears with residual hyperpigmentation, which may take months to fade. One must be careful not to continue to treat this secondary phenomenon. Topical broad-spectrum antibiotics are also effective. Erythromycin, tetracycline, and clindamycin can be easily and inexpensively compounded in cream or lotions in 2 to 3% concentration for this purpose. Systemic use of azoles is ineffective.

Systemic Therapy

On rare occasions, extensive or inflammatory erythrasma may justify systemic treatment. A short course of oral erythromycin is the agent of choice. Tetracycline is an effective alternative.

Posttreatment Prophylaxis

Relapse is a problem, especially in obese, bedridden, inactive, and institutionalized patients. A regular program of cleansing with an antibacterial soap, proper aeration of

Erythrasma Miconazole


Figure 1: Macrodistribution of erythrasma.


Figure 1: Macrodistribution of erythrasma.

intertriginous skin, loose clothing, and use of a 2% miconazole dusting power should prevent relapses.

Conditions That May Simulate Erythrasma

Pityriasis (Tinea) Versicolor

Although individual lesions may be similar in appearance, pityriasis versicolor has a distinctly different distribution.

Erythrasma is intertriginous while P. versicolor affects central regions. Generalized erythrasma can confuse the examiner; however, it still involves creases, which P. versicolor spares. Differentiation can be accomplished by KOH prep and a Wood's lamp examination. KOH exam is positive in P. versicolor. Coral-red fluorescence on Wood's lamp examination occurs only with erythrasma.

Intertriginous Dermatophytosis (Tinea)

Intertriginous fungal infections have a similar distribution but are usually more inflammatory and more symptomatic than erythrasma. They also often show a raised advancing border with loose scale. The difference can be best established by KOH prep, which is positive in dermatophytosis. Coral-red fluorescence on Wood's lamp examination occurs only with erythrasma. Intertriginous dermatophytosis does not fluoresce.

Intertriginous Monilia (Candida)

Intertriginous monilia also has a distribution similar to erythrasma. Monilia is usually very inflammatory and has a moist erosive surface with satellite lesions. Again, KOH or Wood's lamp examination should separate them. Monilia does not fluoresce.

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