{"id":14522,"date":"2023-09-22T11:59:43","date_gmt":"2023-09-22T10:59:43","guid":{"rendered":"https:\/\/touchinfectiousdiseases.com\/?p=14522"},"modified":"2023-11-03T17:29:24","modified_gmt":"2023-11-03T17:29:24","slug":"erythrasma-a-superficial-cutaneous-bacterial-infection-overlooked-in-clinical-practice","status":"publish","type":"post","link":"https:\/\/touchinfectiousdiseases.com\/bacterial-infections\/journal-articles\/erythrasma-a-superficial-cutaneous-bacterial-infection-overlooked-in-clinical-practice\/","title":{"rendered":"Erythrasma: A Superficial Cutaneous Bacterial Infection Overlooked in Clinical Practice"},"content":{"rendered":"<h1 id=\"276b75b0-02c5-488b-b020-ab33e0ece46b\" class=\"jrnlHead1\">Article highlights<\/h1>\n<ul id=\"2d3f254f-834f-4812-992d-0ca14e6709c9\">\n<li id=\"8e458740-3d74-4f0c-a557-3357c322f751\">\n<p id=\"a79aa2e5-d857-4723-8f7c-e2cf5af77253\" class=\"jrnlListPara\">Erythrasma is a common chronic superficial cutaneous bacterial infection caused by Corynebacterium minutissimum when conditions are conducive.<\/p>\n<\/li>\n<li id=\"c0657bb9-ed09-4f45-ab4b-b0bf8b73aabc\">\n<p id=\"3f8d8f10-3e83-4471-9c19-1aecaf885008\" class=\"jrnlListPara\">Corynebacterium minutissimum produces coproporphyrin III (a phosphor) that emits a coral pink fluorescence under Wood\u2019s lamp and helps confirm the diagnosis of erythrasma.<\/p>\n<\/li>\n<li id=\"8e4877b5-5a26-4036-bca1-211b442cc75d\">\n<p id=\"5f5765b3-b27e-4293-8e20-00493ec61b21\" class=\"jrnlListPara\">Smears, cultures and biopsies are only needed in a minority of patients with erythrasma.<\/p>\n<\/li>\n<li id=\"d8331b4e-c6e4-4bf7-9c82-24021baad6fb\">\n<p id=\"4d63c950-7f00-46ed-965d-eebacd3bf00f\" class=\"jrnlListPara\">Erythrasma lesions may be confused with other common skin disorders; identifying the clinical and laboratory features of these conditions helps in the differential diagnosis.<\/p>\n<\/li>\n<li id=\"ebca7c31-7692-4c27-873f-f03cd9a317ae\">\n<p id=\"bb4130b9-ea50-4c27-b67b-d25e334bbf60\" class=\"jrnlListPara\">Coinfection with fungi or superinfection upon primary dermatosis can occur in erythrasma.<\/p>\n<\/li>\n<li id=\"eaddd308-3c58-4d63-9fb7-83e30db54387\">\n<p id=\"e1b5b940-6f45-4af8-8588-d974cd63d2c6\" class=\"jrnlListPara\">The treatment of erythrasma consists of topical and\/or oral antibiotics.<\/p>\n<\/li>\n<li id=\"de0cd074-d964-4619-8d8b-0faacb5f2c92\">\n<p id=\"fe5a8c3c-816c-45c2-a149-8ea8ee237662\" class=\"jrnlListPara\">Re-treatment is effective for recurrent infection; the prevention of erythrasma entails reducing risk factors and using antibacterial soaps.<\/p>\n<\/li>\n<\/ul>\n<p id=\"fa953771-7ecd-4e62-9810-783e40e6594b\" class=\"jrnlSecPara\">Erythrasma is a common chronic superficial cutaneous bacterial infection caused by\u00a0<em id=\"899819ee-b49a-46b2-a98a-51597e35c40f\">Corynebacterium minutissimum<\/em>\u00a0<span id=\"6fb8a64f-78f1-4b1a-90ef-c677ff91cd59\" class=\"styrm cts-5\">(<\/span><em id=\"b881c627-a22a-4fab-aaed-7de07410f744\">C.\u00a0<span id=\"2a34a204-a885-4ccd-85fd-c3b190c1c9e9\">minutissimum<\/span><\/em><span id=\"ef7836ab-c4bf-411e-8e1e-50f6cfb49e6c\" class=\"styrm cts-5\">)<\/span>, a normal inhabitant of the skin flora. In 1862, the German dermatopathologist <span id=\"8e55e9cd-d796-457e-9a7b-108322660a99\">Friedrich Wilhelm Felix<\/span>\u00a0von B\u00e4rensprung coined the name erythrasma to describe this condition and named the organism that caused it\u00a0<em id=\"7e15898a-17b6-4f02-b1b7-2fa867044544\">Microsporum minutissimum<\/em>. The nomenclature has undergone metamorphosis several times, and subsequently, the bacteria responsible for erythrasma was reclassified as\u00a0<em id=\"4685481f-5b32-4d15-9b72-a92070606d48\">C. minutissimum<\/em>. In 1884, K<span id=\"4d14df5d-ddcd-4e83-b4c2-ba721f8a76c4\">\u00f6<\/span>bner proved its transmissibility by applying the epidermal scales from an individual infected with <span id=\"b9bd2461-f9ae-482e-b472-aebf3942165b\">erythrasma\u00a0<\/span>to a healthy person. In 1961,\u00a0<em id=\"58b17f60-ac0d-4426-afef-523a6a0400ca\">C. minutissimum<\/em>\u00a0was isolated from erythrasma lesions for the first time.<span id=\"300d0adc-6e99-4cf1-a7d9-cd09fe654ff8\" class=\"jrnlBibRef\" data-citation-string=\" R1 \"><sup id=\"bf3f6161-5217-4385-9ac9-f1163031f21b\">1<\/sup><\/span><\/p>\n<p id=\"8e5706b2-72a6-47c4-adc9-6b0074f7d904\" class=\"jrnlSecPara\">The disease affects predominantly adults but is occasionally reported in children and adolescents.<span id=\"12b7cd89-e1a8-4871-8b54-e8c321877467\" class=\"jrnlBibRef\" data-citation-string=\" R2 \"><sup id=\"e83aba17-a1ff-40c9-a566-377e2506fe6e\">2<\/sup><\/span> Although equally distributed among men and women, erythrasma affecting the groin is more common in men, and interdigital erythrasma is more common in women.<span id=\"b76668eb-278a-4b9f-b672-d335d21c934f\" class=\"jrnlBibRef\" data-citation-string=\" R3 \"><sup id=\"e1352623-5e44-43b9-bbb7-020ced54f7da\">3<\/sup><\/span>\u00a0The estimated prevalence of this condition is between 4% and 15% in the general population, 18% in older adults and 44% in patients with diabetes mellitus (toe web space).<span id=\"75cfc6e0-236a-42be-ba8e-42107f52de4a\" class=\"jrnlBibRef\" data-citation-string=\" R4 \"><sup id=\"16dd13c2-dac3-47df-b93a-f9e4ff7993ed\">4<\/sup><\/span>\u00a0In a study from Bulgaria, erythrasma was identified in 39% of athletes and 40% of soccer players; both groups had predisposing factors for developing the disease.<span id=\"15f77c76-8b6f-46ad-a11b-69aededf163f\" class=\"jrnlBibRef\" data-citation-string=\" R5 \"><sup id=\"cd17d5a6-cf4d-488f-a176-7c04e7028a7c\">5<\/sup><\/span> In a study from skin clinics in New Zealand, erythrasma was the most commonly diagnosed infection.<span id=\"c68f43ec-0930-43c0-8a0b-7eed9ef8315d\" class=\"jrnlBibRef\" data-citation-string=\" R6 \"><sup id=\"0b17a53e-9dbe-48f0-8936-b2060e9121a0\">6<\/sup><\/span>\u00a0In two independent studies from Turkey, the prevalence of erythrasma in the web spaces of the toes was over 40%.<span id=\"9c50367c-6e60-43d5-8361-3d13248a1652\" class=\"jrnlBibRef\" data-citation-string=\" R7 R8 \"><sup id=\"ebd9b68a-2843-429d-b765-bef01b9a5c13\">7,8<\/sup><\/span>\u00a0A prospective longitudinal observational study from Mexico estimated a prevalence of around 33%.<span id=\"971f3b9b-59a5-4a8a-a980-cf6eaa0a06e9\" class=\"jrnlBibRef\" data-citation-string=\" R3 \"><sup id=\"d7182bc3-9e52-429d-b316-f40c5385e398\">3<\/sup><\/span> A study of military recruits in Denmark yielded a prevalence of approximately 50%.<span id=\"8b28d7a1-65fd-4598-a21b-9d5ebd11cb52\" class=\"jrnlBibRef\" data-citation-string=\" R9 \"><sup id=\"d94c7f6d-b6fb-4b30-aa89-2e71c07d3a18\">9 <\/sup><\/span>Finally, a study from India showed a prevalence of\u00a0<span id=\"0bc94175-a0e7-4e8c-8ab6-c72c398f1c90\">erythrasma<\/span>\u00a0of 50% among patients with diabetes and 62.5% among those who are obese.<span id=\"6a0402de-fb5b-4185-8199-45dc86337e50\" class=\"jrnlBibRef\" data-citation-string=\" R10 \"><sup id=\"032b9393-2cdb-4fab-bf4e-4509b9979607\">10<\/sup><\/span><\/p>\n<p id=\"1361b8e7-f6fa-420d-b815-b6e36b9db1ba\" class=\"jrnlSecPara\">Erythrama occurs frequently in obesity and diabetes, two common conditions in internal medicine. Unfortunately, the training curriculum in that speciality does not emphasise this condition. This often leads to misdiagnosis and a protracted clinical course.<span id=\"7b4c219e-d03f-4cd2-93d6-8d787276931b\" class=\"jrnlBibRef\" data-citation-string=\" R11 R12 \"><sup id=\"155a5ac4-b0f4-424a-b7fa-0bd92df16a8e\">11,12<\/sup><\/span>\u00a0The following paragraphs provide a comprehensive review of the topic to educate practitioners and trainees in internal medicine and its subspecialties.<\/p>\n<h1 id=\"a4faa3db-2bdd-4763-afb5-81e1bae329db\" class=\"jrnlHead1\"><em id=\"c530621d-e127-4442-ba1a-4a447ef6c055\">Corynebacterium minutissimum<\/em><\/h1>\n<p id=\"d8753312-5417-4d78-878b-ab3b741c2d21\" class=\"jrnlSecPara\"><em id=\"cc709efc-88db-427e-a4df-fd1091b313a3\">C. minutissimum<\/em>\u00a0is a gram-positive, lipophilic, non-capsular, aerobic or facultative anaerobic, non-spore-forming, catalase-producing bacillus presenting as rods or filaments and found as a commensal in the skin (see\u00a0<span class=\"jrnlFigRef\" data-citation-string=\" F1 \">Figure 1<\/span>\u00a0for taxonomy). A favourable environment permits the bacillus to invade the stratum corneum, where it multiplies, leading to the expansion of this skin layer.<span id=\"6e57b512-63a8-4dfc-a8c3-cff4763e0fbb\" class=\"jrnlBibRef\" data-citation-string=\" R1 \"><sup id=\"fad56367-b219-4bf2-a0ca-ff7242330fa5\">1<\/sup><\/span><\/p>\n<div id=\"a6b84952-0938-4c38-a8e3-b1b0072b95e7\" class=\"jrnlFigBlock\">\n<p id=\"9478df2a-05ee-4536-ba21-2ee887972081\" class=\"jrnlFigCaption\"><span class=\"label\">Figure 1: <\/span>Taxonomy of\u00a0<em id=\"b61b3358-3239-45a2-8d99-4e5bd0dfaaa9\">Corynebacterium minutissimum<\/em>, the causative organism of erythrasma<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-14537\" src=\"https:\/\/touchinfectiousdiseases.com\/wp-content\/uploads\/sites\/19\/2023\/09\/figure-1-touchINFECTDIS-D-23-00004-Erythrasma-A-Superficial-Cutaneous-Bacterial-Infection-Overlooked-in-Clinical-Practice.png\" alt=\"\" width=\"271\" height=\"276\" \/><\/p>\n<\/div>\n<p id=\"e6b200c6-efe9-457b-8922-1bc098a80fde\" class=\"jrnlSecPara\">Light microscopy from skin biopsies reveals numerous club-shaped bacilli (<em id=\"08e3357d-db79-4909-90f3-83c8129e29af\">Corynebacterium<\/em>) forming a \u2018picket fence\u2019 and mostly occupying the superficial stratum corneum with only a few numbers in the lower part of this layer. Sometimes, a mild perivascular lymphocytic infiltrate is seen.<span id=\"b0f9a8ed-4b9e-40b2-a052-571cf6d93429\" class=\"jrnlBibRef\" data-citation-string=\" R13 \"><sup id=\"22924ff8-a98e-44cd-980d-748a2309a5ef\">13<\/sup><\/span><\/p>\n<p id=\"f20e10b7-e5e5-410a-bb06-b69fc5581d42\" class=\"jrnlSecPara\">The ultrastructure of this bacterium has been defined by electron microscopy. It reveals a thick cell wall that provides a defence or, in some circumstances, the formation of a distinct mucopolysaccharide sheath. The bacterium produces keratolysis at the site of proliferation in the superficial skin; this keratolysis is seen as decreased electron density around the organism and helps spread infection.<span id=\"e12fe81c-3cd6-4da4-bc84-890548d9a06f\" class=\"jrnlBibRef\" data-citation-string=\" R14 \"><sup id=\"37718db7-3c43-412b-9f5a-4c7f4813d77d\">14<\/sup><\/span>\u00a0<span id=\"a5485502-848b-4c8d-a2e4-12468927f73c\">This was the first time that subcellular organelles were demonstrated\u00a0<em id=\"bec78b28-9818-417c-a935-25403cfe6d99\" class=\"sty cts-7\">C. minutissimum<\/em>\u00a0by electron microscopy.\u00a0<\/span>Well-orchestrated subcellular organelles are a distinctive finding. An elaborate network of mitochondrial enzymes, including nicotinamide adenine dinucleotide phosphate, is a hallmark of enzyme histochemical tests.<span id=\"c6721d1b-6772-455f-a37b-f4af4f6f3294\" class=\"jrnlBibRef\" data-citation-string=\" R15 \"><sup id=\"20bdab77-412f-4c1d-b4a9-e9d8a346a4c9\">15<\/sup><\/span>\u00a0<em id=\"fa5eec68-a188-44b9-acbb-3502198be35c\" class=\"sty cts-5\">C. minutissimum<\/em>\u00a0also has the ability to metabolise various sugars, including glucose.<span id=\"5fe5c8ec-b67e-4b9f-93a8-a0f5a40ed763\" class=\"jrnlBibRef\" data-citation-string=\" R16 \"><sup id=\"da30e992-3739-475c-ab02-aacd93df001d\">16<\/sup><\/span>\u00a0This ability may explain its increased occurrence in patients with diabetes. However, the machinery for invading the deeper skin layers is postulated to be absent, explaining the persistence of infection to the skin surface in patients who are immunocompetent. The genome for this organism has been decoded and reveals 2,469 protein-coding regions, 51 transfer RNA genes and 3 ribosomal RNA operons.<span id=\"1af5ae09-02df-4a65-ac5d-44d1810145ea\" class=\"jrnlBibRef\" data-citation-string=\" R17 \"><sup id=\"fce1293a-06ca-496e-b952-671010428477\">17<\/sup><\/span>\u00a0This information may be important for studying antibiotic sensitivity and resistance patterns.<\/p>\n<p id=\"fc57e42d-2c29-4f8b-890d-54e192e4c108\" class=\"jrnlSecPara\">Japanese investigators have isolated other\u00a0<em id=\"dd2bdaaf-cece-48f5-94b8-b4787f2f3b3d\">Corynebacterium<\/em>\u00a0species from erythrasma lesions (<em id=\"5514d57f-75f1-46f2-9c45-4b45acab8de5\">Corynebacterium aurimucosum<\/em>\u00a0and\u00a0<em id=\"caa16365-0bc4-4388-b02e-599e22e5cc9f\">Microbacterium oxydans<\/em>) that produced coproporphyrin III and fluoresced under Wood\u2019s lamp.<span id=\"7141e7e9-c01d-4f73-b661-eff489d13980\" class=\"jrnlBibRef\" data-citation-string=\" R18 \"><sup id=\"1ba94625-2f00-498b-a55f-30831a674a3f\">18<\/sup><\/span><\/p>\n<p id=\"9b120a62-0921-4357-ba4d-43431bde338d\" class=\"jrnlSecPara\">Apart from erythrasma,\u00a0<em id=\"bbc5129c-c649-40b0-a821-d7fe6652c242\">C. minutissimum<\/em>\u00a0causes pitted keratolysis and\u00a0<span id=\"492522ee-d5a6-4b32-8acc-95bc99670dc4\" class=\"styrm cts-5\">trichobacteriosis<\/span>.<span id=\"f8612eb6-ee54-4647-9df1-d898b86954fe\" class=\"jrnlBibRef\" data-citation-string=\" R19 \"><sup id=\"9e3cab63-7683-441f-8522-e3f8d3f6538e\">19<\/sup><\/span> Pitted keratolysis and <span id=\"d2edd24d-01e8-4ef5-b625-507dfb1d85bd\" class=\"styrm cts-5\">trichobacteriosis are <\/span>bacterial infections of the superficial skin and hair, respectively; they are easily distinguished from each other by their distinctive features.<span id=\"051b5cea-a5d0-4dc2-a862-5377a4b926c8\" class=\"jrnlBibRef\" data-citation-string=\" R19 \"><sup id=\"5f88b068-174d-4a57-bdc9-f09b63f40cfa\">19<\/sup><\/span><\/p>\n<p id=\"9f40a34d-0e42-4571-aabe-967d7cd0517a\" class=\"jrnlSecPara\">In hosts who are immunocompromised,\u00a0<em id=\"b5a461a4-fa2d-449c-8075-a53222e2bff7\">C. minutissimum<\/em>\u00a0can cause invasive infections such as catheter-related bloodstream infections, prosthetic device and graft infections, peritonitis (in patients receiving peritoneal dialysis), abscesses, postoperative wound infections, osteomyelitis, endocarditis, embolic ocular infections, meningitis, brain abscess, and pyelonephritis.<span id=\"d93ed1f4-8544-4cbf-8a32-83c9162f11a0\" class=\"jrnlBibRef\" data-citation-string=\" R20 R21 R22 R23 R24 R25 R26 R27 R28 R29 R30 \"><sup id=\"df599299-6712-4926-8f55-cb02aba3dfa8\">20\u201330<\/sup><\/span> It is plausible that erythrasma increases the risk for invasive infection in such individuals, although evidence for this is lacking. Rare cases of invasive infections in adults who are immunocompetent have been reported.<span id=\"4ad77007-98b4-4979-b019-6224543136d1\" class=\"jrnlBibRef\" data-citation-string=\" R16 \"><sup id=\"19d50196-555d-4c8f-8e05-f0f05fd27bfc\">16<\/sup><\/span><\/p>\n<h1 id=\"59ec3cf7-cf04-41be-a77e-2e530eea35d1\" class=\"jrnlHead1\">Risk factors of erythrasma<\/h1>\n<p id=\"6b8c8fdb-dbb2-42fb-89ce-82e87130ab15\" class=\"jrnlSecPara\">Many risk factors are associated with erythrasma, including hyperhidrosis and obesity, which are conditions that promote a moist environment and skin denudation.<span id=\"2df8959f-7ca8-4750-8c73-f50fe2c7f322\" class=\"jrnlBibRef\" data-citation-string=\" R10 R11 \"><sup id=\"adb5929d-c31e-4cbd-9a22-d0e8fb289c61\">10,11<\/sup><\/span> Patients with diabetes or who are immunocompromised are at a higher risk of developing <span id=\"5043763a-ae93-41f0-a4ca-460369bbca0b\">erythrasma<\/span>\u00a0as they have diminished defences against the bacterium.<span id=\"6093c3fe-a00d-4984-aa85-6012d32d1d4d\" class=\"jrnlBibRef\" data-citation-string=\" R12 R31 \"><sup id=\"574823ac-9b27-4558-b8e8-ce805522c2a9\">12,31<\/sup><\/span>\u00a0Athletes and sportspersons are also at a higher risk as they are covered with clothing for prolonged periods, and sweat and friction promote bacterial multiplication.<span id=\"cd998969-7248-4103-a52b-616916a7151b\" class=\"jrnlBibRef\" data-citation-string=\" R5 \"><sup id=\"4d886a24-5f2d-4eaf-9b09-5f3daaca4576\">5<\/sup><\/span> Overcrowding and poor hygiene in care homes for older adults, hostels, refugee camps, prisons and mental health institutions can promote spread through close contact.<span id=\"85695c0c-81e0-4c06-a52a-a650b5605a27\" class=\"jrnlBibRef\" data-citation-string=\" R32 \"><sup id=\"f061b93a-45e6-4f37-9f6f-b8f099a7a850\">32 <\/sup><\/span>Living in tropical environments also contributes to multiple risk factors, such as increased sweating, poor hygiene and overcrowding.<span id=\"dbf73914-b90f-4b24-aa97-8552a7972ea4\" class=\"jrnlBibRef\" data-citation-string=\" R33 \"><sup id=\"8a9508de-8ec2-4032-ab88-46c7d4c432f4\">33<\/sup><\/span><\/p>\n<h1 id=\"5c19fddd-d5dd-4264-83d8-8a32afd80b9e\" class=\"jrnlHead1\">The diagnosis of erythrasma<\/h1>\n<h2 id=\"08a6db7e-28d3-491b-b738-68a6923e6747\" class=\"jrnlHead2\">Clinical picture<\/h2>\n<p id=\"69d5e7f9-1df5-478b-8a54-7d0d86717e7a\" class=\"jrnlSecPara\">Most patients with erythrasma are asymptomatic.<span id=\"c1b97bd9-2883-42e4-8f92-e5202c354d4a\" class=\"jrnlBibRef\" data-citation-string=\" R1 \"><sup id=\"224f7bed-bfb6-4d46-aef4-db7025c4c54c\">1<\/sup><\/span>\u00a0A few may complain of pruritus, which is usually mild. Mild burning in the affected areas is rarely reported. Yet, others may complain of cosmetically disturbing skin discolouration. In many patients, erythrasma may be discovered by chance while examining the patient for other conditions, such as fungal skin disease and skin lesions of leprosy in tropical countries, or checking for moles.<span id=\"6d1a8836-b78f-4c3e-ac40-6909f2b2877c\" class=\"jrnlBibRef\" data-citation-string=\" R1 \"><sup id=\"21365551-01fb-4a78-ae12-9da903246438\">1<\/sup><\/span><\/p>\n<p id=\"87dcc1b5-6f65-4ab2-93f9-ffed584b2c6b\" class=\"jrnlSecPara\">Erythrasma is most commonly found in flexural folds: the axilla, submammary, groin, intergluteal, periumbilical, and perianal areas and web spaces between the toes, where the conditions are moist, occluded and macerated by friction.<\/p>\n<p id=\"69756402-db1b-4891-bf7d-0a92ebf7e715\" class=\"jrnlSecPara\">Erythrasma lesions have been classified as interdigital (toes) or truncal (body areas).<span id=\"fb1cdada-404b-4154-8b42-135fdc163bde\" class=\"jrnlBibRef\" data-citation-string=\" R1 R4 \"><sup id=\"75e40519-bc86-4597-aba9-e5a083f4e487\">1,4<\/sup><\/span>\u00a0The lesions on the trunk are well demarcated with wavy margins and typically red or brown macules or plaques. The surface of the lesions presents fine scales and may appear wrinkled and sometimes with fissures. Axillary lesions may spread to the inner aspect of the upper arm. In people with darker skin tones, the condition may present as hypopigmented patches with darkened border fissures (<span class=\"jrnlFigRef\" data-citation-string=\" F2 \">Figure 2<\/span>).<span id=\"f59702b6-e2b3-4d6c-b637-56a4e3a4fed4\" class=\"jrnlBibRef\" data-citation-string=\" R4 \"><sup id=\"17edb8e5-840d-443b-8b3a-b750e5eccb65\">4<\/sup><\/span>\u00a0Extensions and satellite lesions may occur; lesions may coalesce onto neighbouring ones and increase and decrease over time. Normal skin may occur between lesions.<span id=\"66f64514-a9aa-401b-91f5-1217062cd4a2\" class=\"jrnlBibRef\" data-citation-string=\" R34 R35 \"><sup id=\"a7738600-9af1-4adf-af55-22742ed0144e\">34,35<\/sup><\/span><\/p>\n<div id=\"d06e2ab8-e07b-4fd2-99a2-fec6684526c4\" class=\"jrnlFigBlock\">\n<p id=\"ff701dc0-9a25-405e-b32b-9b443d69d81c\" class=\"jrnlFigCaption\"><span class=\"label\">Figure 2: <\/span>Erythrasma of the axilla<\/p>\n<\/div>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-14532\" src=\"https:\/\/touchinfectiousdiseases.com\/wp-content\/uploads\/sites\/19\/2023\/09\/figure-2-touchINFECTDIS-D-23-00004-Erythrasma-A-Superficial-Cutaneous-Bacterial-Infection-Overlooked-in-Clinical-Practice-174x300.png\" alt=\"\" width=\"174\" height=\"300\" srcset=\"https:\/\/touchinfectiousdiseases.com\/wp-content\/uploads\/sites\/19\/2023\/09\/figure-2-touchINFECTDIS-D-23-00004-Erythrasma-A-Superficial-Cutaneous-Bacterial-Infection-Overlooked-in-Clinical-Practice-174x300.png 174w, https:\/\/touchinfectiousdiseases.com\/wp-content\/uploads\/sites\/19\/2023\/09\/figure-2-touchINFECTDIS-D-23-00004-Erythrasma-A-Superficial-Cutaneous-Bacterial-Infection-Overlooked-in-Clinical-Practice.png 271w\" sizes=\"(max-width: 174px) 100vw, 174px\" \/><\/p>\n<p id=\"3f013985-df44-4da6-a057-e855deaa0a61\" class=\"jrnlSecPara\"><em>Photo showing reddish patches (arrows), brown hyperpigmented areas (starred) with fine scaly and wrinkled surface. The borders are well demarcated, wavy and extend into the inner aspect of the arm (lower part of photo). Patient received topical fusidic acid with resolution. Photo provided by the author. Patient consent was obtained but deidentified completely.<\/em><\/p>\n<p class=\"jrnlSecPara\">The skin may get lichenified and develop postinflammatory hyperpigmentation or contact dermatitis from topical therapeutic agents. Web space infection between the toes may present as macerated areas, a red rash or vesiculobullous lesions. They may be painful, itchy or asymptomatic. The physician should separate the toes and examine each web space in good lighting to avoid missing any lesions.<span id=\"45ad5538-fdd4-4c63-941a-6ef90001374c\" class=\"jrnlBibRef\" data-citation-string=\" R7 \"><sup id=\"2dd42b63-f297-494e-b7fa-241cbf61ca3e\">7<\/sup><\/span> Atypical presentations are disciform (localized and generalized), subungual, melanotic, vulvar and palmar lesions. Widespread infection may occur.<span id=\"eee91818-140d-487d-9034-2c5f95141599\" class=\"jrnlBibRef\" data-citation-string=\" R36 R37 R38 R39 R40 \"><sup id=\"02a23c3d-1817-4731-87c1-bc973a2ab418\">36\u201340<\/sup><\/span><\/p>\n<p class=\"jrnlSecPara\">Various clinical manifestations of\u00a0<em id=\"b7333248-8950-4dbd-84b3-f6973f7f70bc\">C.minutissimum,<\/em>\u00a0namely pitted keratolysis, erythrasma and\u00a0<em id=\"b5f9150c-8bf7-42b5-b318-7e6f9299b9a0\">trichobacteriosis,<\/em>\u00a0may co-occur in the same patient.<span id=\"a0c53288-1a3a-4cd6-a48c-6caa943af89f\" class=\"jrnlBibRef\" data-citation-string=\" R41 \"><sup id=\"bd5177a1-3c93-4f0a-8a91-1fba663a1c48\">41<\/sup><\/span>\u00a0Coinfection with dermatophytes, other bacteria, and candida has been described.<span id=\"725b6bdb-2c1f-40fc-9702-d9a24ec2dde0\" class=\"jrnlBibRef\" data-citation-string=\" R42 R43 \"><sup id=\"459be102-6b65-4f6d-8e2b-5e9b8122fafa\">42,43<\/sup><\/span>\u00a0Clinically persistent lesions after prolonged and repeated courses of topical and\/or systemic antifungals should prompt a search for coinfection.<\/p>\n<p id=\"da11db73-03c4-4b63-a970-98e87d339733\" class=\"jrnlSecPara\">Superinfection upon primary dermatosis, such as psoriasis, hidradenitis, seborrheic dermatitis and pityriasis versicolor, has been recorded. A worsening or increased severity of the primary skin lesions should prompt a search for superinfection.<span id=\"f871c474-cb60-4b17-988e-d47a456ee4f6\" class=\"jrnlBibRef\" data-citation-string=\" R44 \"><sup id=\"ee4af429-0067-48c9-a3b9-6163e8b1b166\">44<\/sup><\/span><\/p>\n<p id=\"7506fb88-8f82-4a1a-aa60-e9274f0d14ef\" class=\"jrnlSecPara\">Recurrent lesions after initial resolution should prompt a search for diabetes mellitus or HIV infection.<\/p>\n<p id=\"0a7f9569-74c0-419a-8b7b-388708b4f215\" class=\"jrnlSecPara\">The first step\u00a0<span id=\"6aef717f-b1e7-4ee3-b47e-784c8ad4db62\">in establishing a diagnosis of erythrasma<\/span>\u00a0is establishing the clinical diagnosis. The diagnosis of erythrasma is achieved by maintaining a high index of suspicion in patients with risk factors and clinical characteristics, followed by a Wood\u2019s lamp examination. In most cases, this will suffice\u00a0<span id=\"9ad7c61a-aca7-4d4e-8752-8cd3bac3b51c\">for diagnosing erythrasma<\/span>.<\/p>\n<h2 id=\"182a60da-b54e-4d44-9bc4-88f5f3b0310c\" class=\"jrnlHead2\">Wood&#8217;s lamp<\/h2>\n<p id=\"d05e6b41-ecbe-49bd-9da4-20f24ef35ed4\" class=\"jrnlSecPara\">In 1903, Robert Williams Wood developed the Wood\u2019s lamp, a device that uses special filters to block visible light but allow ultraviolet light to pass through. In dermatology, it is used to diagnose several bacterial, fungal, parasitic and pigmentation disorders.<span id=\"a9b53da4-5fe3-4aa3-bbee-d22ba2176b67\" class=\"jrnlBibRef\" data-citation-string=\" R45 R46 R47 \"><sup id=\"e61c2d07-4fd0-490a-a3fb-eb613bb7f161\">45\u201347<\/sup><\/span>\u00a0The ultraviolet light induces fluorescence by reacting with pigments (phosphors) produced by an organism. This way, different colours produced by various organisms help distinguish them in a rapid and noninvasive manner. The device is safe to use but will need a dark room with all ambient lights turned off during the brief examination.<span id=\"cd68b159-6c2b-4b7f-9409-50af2f4a4dd9\" class=\"jrnlBibRef\" data-citation-string=\" R47 \"><sup id=\"20738ce4-f4ce-4170-88a1-bd6456f1a87f\">47<\/sup><\/span><\/p>\n<p id=\"c33eef3e-439a-4539-815e-fc224b7087d1\" class=\"jrnlSecPara\"><em id=\"533f9bdd-9c14-439e-9bd5-6e73fc79b257\">C. minutissimum<\/em>, the causative organism of erythrasma, produces coproporphyrin III (a phosphor) that emits a coral pink fluorescence with ultraviolet light (<span class=\"jrnlFigRef\" data-citation-string=\" F3 \">Figure 3<\/span>). This reaction is characteristic of erythrasma and is useful for confirming the diagnosis of the condition, especially in coinfection with tinea, where there is a suboptimal response to antifungals alone. However, the practitioner must ensure that the affected area is not washed or cleaned as the water-soluble coproporphyrin III (and uroporphyrin I) will be washed off, and results will be falsely negative. Some detergents and other substances may cause false positive results.<span id=\"1a1c3805-0e82-4f2d-9431-2f7d67ab1939\" class=\"jrnlBibRef\" data-citation-string=\" R47 \"><sup id=\"13d76222-821c-4dd2-bba9-65282c12b20f\">47<\/sup><\/span><\/p>\n<div id=\"cdcad9c9-ab8c-4423-bbaa-4ed915ad20a6\" class=\"jrnlFigBlock\">\n<p id=\"422b6431-7992-40f4-8955-b6f44b3cc9bc\" class=\"jrnlFigCaption\"><span class=\"label\">Figure 3: <\/span>Wood\u2019s lamp examination of erythrasma affecting the axillary region<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-14527\" src=\"https:\/\/touchinfectiousdiseases.com\/wp-content\/uploads\/sites\/19\/2023\/09\/figure-3-touchINFECTDIS-D-23-00004-Erythrasma-A-Superficial-Cutaneous-Bacterial-Infection-Overlooked-in-Clinical-Practice-172x300.png\" alt=\"\" width=\"172\" height=\"300\" srcset=\"https:\/\/touchinfectiousdiseases.com\/wp-content\/uploads\/sites\/19\/2023\/09\/figure-3-touchINFECTDIS-D-23-00004-Erythrasma-A-Superficial-Cutaneous-Bacterial-Infection-Overlooked-in-Clinical-Practice-172x300.png 172w, https:\/\/touchinfectiousdiseases.com\/wp-content\/uploads\/sites\/19\/2023\/09\/figure-3-touchINFECTDIS-D-23-00004-Erythrasma-A-Superficial-Cutaneous-Bacterial-Infection-Overlooked-in-Clinical-Practice.png 270w\" sizes=\"(max-width: 172px) 100vw, 172px\" \/><\/p>\n<p class=\"jrnlFigFoot\"><em>Wood\u2019s lamp examination of erythrasma affecting the axillary region shows coral-pink fluorescence (arrows). Disease extension to the inner aspect of the upper arm is seen in the lower part of the photo. Normal skin has blue colour (arrowhead). Whitish lesions (starred) reflect thickened areas of skin. Photo provided by the author. Patient consent obtained but de-identified completely.<\/em><\/p>\n<\/div>\n<p id=\"25561d2a-7bda-4b76-9f8a-94b67995887d\" class=\"jrnlSecPara\">Unfortunately, Wood\u2019s lamp is underused in clinical practice. In India, many primary care providers are unaware of such a diagnostic device, and only a few dermatologists use it in their clinics despite its affordability.<\/p>\n<p id=\"b6b78108-6a22-4ba6-974d-ba26a3100b1f\" class=\"jrnlSecPara\">Some authors have suggested using the blue light function in smartphones as an alternative to Wood\u2019s lamp; however, these findings come from a study on vitiligo that did not include individuals with erythrasma.<span id=\"1ff6be8c-91d9-4cfd-b88c-b594e96adc72\" class=\"jrnlBibRef\" data-citation-string=\" R48 \"><sup id=\"30a45a80-62d1-48d2-9bfb-f07cbc761325\">48<\/sup><\/span>\u00a0As most physicians use smartphones, this would be an attractive alternative to Wood\u2019s lamp. More studies are needed to validate the effectiveness and safety of this method in the diagnosis of erythrasma and other disorders.<\/p>\n<h2 id=\"f44d6d3e-3898-49fc-9bc0-1b56ef7485d8\" class=\"jrnlHead2\">Skin biopsy and culture<\/h2>\n<p id=\"8ae49b1a-9db8-4c9b-aed3-4722d4061638\" class=\"jrnlSecPara\">In cases where the diagnosis of erythrasma is in doubt, as in the case of atypical presentations, skin biopsy with histology and cultures may be required. Such cases are best referred to dermatologists with expertise in this area.<\/p>\n<p id=\"25b76962-f4a8-4f07-9054-aed9af499ee5\" class=\"jrnlSecPara\">Biopsy and staining of the lesion with Gram stain or special dyes such as methenamine silver, periodic acid\u2013Schiff and methylene blue reveals the organism in the stratum corneum. The diagnosis can be easily missed with ordinary hematoxylin and eosin stains if the pathologist is not provided with the patient history and the disease is not suspected.<span id=\"94ac18cb-4334-49fa-9fd5-ac8f0f78a5b7\" class=\"jrnlBibRef\" data-citation-string=\" R1 \"><sup id=\"97a7ea3e-83fb-4067-8c29-8d4a91385464\">1<\/sup><\/span><\/p>\n<p id=\"231ad471-f5a6-42f8-8d6e-e6acab5dcdf3\" class=\"jrnlSecPara\">A painless skin surface biopsy technique for examining the stratum corneum has been described.<span id=\"8772bdf8-c5d4-4d52-9127-b56644ad6551\" class=\"jrnlBibRef\" data-citation-string=\" R14 \"><sup id=\"64e26a07-e565-43e3-9b61-bc348decd8af\">14<\/sup><\/span>\u00a0This circumvents the disorganization that accompanies the regular biopsy for histopathology.<span id=\"f718943c-838d-4f18-82b1-d37c0ecfc021\" class=\"jrnlBibRef\" data-citation-string=\" R14 \"><sup id=\"37d97efc-ad68-472c-8781-0d5d4e6941d2\">14<\/sup><\/span>\u00a0A technique that uses an adhesive tape to capture the scales in superficial fungal and bacterial skin infections using a single stain for both organisms has also been described.<span id=\"ec98897d-05ef-4629-9c55-7810727e989d\" class=\"jrnlBibRef\" data-citation-string=\" R49 \"><sup id=\"a61820ff-9a59-44ca-9409-d9b3422333b7\">49<\/sup><\/span>\u00a0For cultures, tissue culture medium no:199 with sheep blood agar and phenol red has proved optimal.<span id=\"7139ec66-04a2-4a2e-9cdd-e6dbfdcbc855\" class=\"jrnlBibRef\" data-citation-string=\" R1 \"><sup id=\"d4d2cf6c-3e92-4704-8574-e9f3313c37f4\">1<\/sup><\/span><\/p>\n<p id=\"114855f0-6615-4c5c-aef5-a9a94b5dfdcc\" class=\"jrnlSecPara\">In routine clinical practice, these procedures are rarely needed for establishing the diagnosis; however, in the cases studied, a combination of Gram stain and Wood\u2019s lamp has yielded better results than either test alone.<\/p>\n<h1 id=\"95afdbb5-ea2b-4439-80ea-1fd851f3beed\" class=\"jrnlHead1\">Differential diagnosis<\/h1>\n<p id=\"d00b96ae-7286-4289-ab27-1bd7f8d7ab51\" class=\"jrnlSecPara\">Atypical presentations of erythrasma can be confused with other skin conditions.<span id=\"f51970b9-dfd6-48f1-bd05-d5a324ccc0ee\" class=\"jrnlBibRef\" data-citation-string=\" R50 R51 R52 \"><sup id=\"03753d5e-c3c4-4045-b50a-ec4bc701a90c\">50\u201352<\/sup><\/span>\u00a0At the same time, many common skin conditions can be misdiagnosed as erythrasma. In the following paragraphs, these conditions are discussed, highlighting their distinguishing features.<\/p>\n<h2 id=\"36d91089-f6bf-452f-8f60-7fdb7b532b7d\" class=\"jrnlHead2\">Intertrigo<\/h2>\n<p id=\"60e5bb53-53bc-4a35-960d-6fa54abdfe9c\" class=\"jrnlSecPara\">Intertrigo is caused by skin maceration due to friction. Many of the risk factors that cause erythrasma play a part in this condition: itching, erythema, maceration, erosions and fissuring. Wood\u2019s lamp tests negative in cases of interigo, and superinfection may occur with candida, fungi and bacteria.<span id=\"d35963d4-293b-4601-830e-6325b5ca70c2\" class=\"jrnlBibRef\" data-citation-string=\" R53 \"><sup id=\"b3254d46-e981-4ab2-9b83-9a0e098663b3\">53<\/sup><\/span><\/p>\n<h2 id=\"aea2622d-9b36-4111-823b-ad76b81527f5\" class=\"jrnlHead2\">Candidiasis<\/h2>\n<p id=\"700dc06f-39d5-4687-ba09-f9ac1fdecf71\" class=\"jrnlSecPara\">Candidiasis also shares common risk factors with erythrasma.<span id=\"5be41cf0-057c-44b9-8c51-10d37976b5ae\" class=\"jrnlBibRef\" data-citation-string=\" R53 \"><sup id=\"2b21d515-6f17-4116-9d86-b0a20f371543\">53<\/sup><\/span>\u00a0The presence of erythematous well-demarcated erosive or dry lesions with satellite papules and pustules is helpful in diagnosing this condition. Wood\u2019s lamp is negative in cases of candidiasis. Pseudohyphae, which are commonly found on candidiasis instead of hyphae, are seen on smear and histology.<span id=\"6c22d23c-70a2-4715-96ba-fb02ba4cb3ce\" class=\"jrnlBibRef\" data-citation-string=\" R53 \"><sup id=\"a2a5c449-0611-413e-ba13-c41a44bd4670\">53<\/sup><\/span><\/p>\n<h2 id=\"602f8594-5876-4b68-a8a5-819c726e516f\" class=\"jrnlHead2\">Pityriasis versicolor<\/h2>\n<p id=\"7008949b-9180-434f-b267-9bfd1c098fc9\" class=\"jrnlSecPara\"><span id=\"3bd66b69-cab2-4b2e-a080-0535220f0873\">In pityriasis versicolor,\u00a0<\/span>lesions are well demarcated with central hypopigmentation and peripheral scaly hyperpigmented macules.<span id=\"ae07628a-65f6-458c-b833-20d233810d33\" class=\"jrnlBibRef\" data-citation-string=\" R50 \"><sup id=\"ff55487a-61a1-4ab4-9380-31613eb87806\">50<\/sup><\/span>\u00a0Skin scraping potassium hydroxide preparation test of this condition reveals spores and hyphae, and histology specimens reveal a &#8216;meatball and spaghetti&#8217; morphology. A\u00a0<span id=\"820623f6-a658-4193-b217-75ef3e6175a5\">orange-yellow<\/span>\u00a0fluorescence with Wood\u2019s lamp is indicative of the presence of pityriasis versicolor.<span id=\"66be0fc6-863c-4a89-b7e4-a2bfd5d95be5\" class=\"jrnlBibRef\" data-citation-string=\" R50 \"><sup id=\"090904db-bc7f-4ddd-b5e8-d7d951321f21\">50<\/sup><\/span><\/p>\n<h2 id=\"28a9ad0f-3874-4bd6-8c37-f544dbed271f\" class=\"jrnlHead2\">Tinea<\/h2>\n<p id=\"ef92e318-9177-4a4b-adff-14fd8ececca1\" class=\"jrnlSecPara\">Tinea is a fungal infection characterized by itching and erythematous scaly lesions with a raised geographic border.<span id=\"85517b49-5a9f-4a45-9d2f-b4edf3cf692c\" class=\"jrnlBibRef\" data-citation-string=\" R54 \"><sup id=\"21130f50-1354-440c-a419-3f06caa56bcb\">54<\/sup><\/span>\u00a0It can affect the feet (tinea pedis), the groin (tinea cruris) and the top layer of the skin throughout the body (tinea corporis). In cases of tinea, Wood\u2019s lamp is negative, although it detects green fluorescence in cases of microspora infection. Finally, potassium hydroxide smear tests are positive, revealing hyphae with septae.<span id=\"5d8fc924-1045-48e4-af4d-f8448644ad09\" class=\"jrnlBibRef\" data-citation-string=\" R54 \"><sup id=\"fbb2eec7-a473-4df7-ae07-9c7f2e3ac628\">54<\/sup><\/span><\/p>\n<h2 id=\"274213e2-58c6-494e-88de-3f6d03ebc751\" class=\"jrnlHead2\">Acanthosis nigricans<\/h2>\n<p id=\"2cd60d29-ef34-4783-bf16-e073d340fd76\" class=\"jrnlSecPara\"><span id=\"42459596-b4f0-4e65-8610-4ad14a8c1fdc\">Acanthosis nigricans<\/span>\u00a0presents as dark, velvety, non-scaly hyperpigmented lesions in the folds (both in flexure and extensor areas).\u00a0<span id=\"0649408e-c73e-4561-85c6-b7aa891beab8\" class=\"jrnlBibRef\" data-citation-string=\" R55 \"><sup id=\"b679eee7-d18f-4cf4-90a0-862ac8b1e9a6\">55<\/sup><\/span>These lesions do not have erythema or annular borders. The condition is often accompanied by obesity and a personal and\/or family history of diabetes. In cases of acanthosis nigricans, Wood\u2019s lamp and potassium hydroxide smear tests result as negative, while histopathology shows characteristic findings and absent organisms.<span id=\"35e8e0cc-eb8d-45d9-99b0-a4050304c717\" class=\"jrnlBibRef\" data-citation-string=\" R55 \"><sup id=\"c4d077e5-c59d-49b7-bcba-4233d0b070d1\">55<\/sup><\/span><\/p>\n<h2 id=\"d74a4ab4-9f2d-4339-ba5e-467a9e89430b\" class=\"jrnlHead2\">Contact dermatitis<\/h2>\n<p id=\"68c08097-e7bd-4f1b-8eaf-5cc3b0fd2033\" class=\"jrnlSecPara\"><span id=\"4e04dea6-2c71-4079-8ff7-4426cbe229d3\">Contact dermatitis<\/span>\u00a0can occur in skin folds. Lesions are erythematous but often not well defined.<span id=\"81e48809-3826-48ee-ab5f-b3969bdee99e\" class=\"jrnlBibRef\" data-citation-string=\" R4 \"><sup id=\"40eaa79b-b018-4df8-89d7-171595db9460\">4<\/sup><\/span>\u00a0A careful history may reveal the use of irritants such as perfumes, and patch testing will help confirm the diagnosis. In cases of contact dermatitis, Wood\u2019s lamp examination is negative.<span id=\"291188c0-510e-42eb-b7d6-8a54443249be\" class=\"jrnlBibRef\" data-citation-string=\" R4 \"><sup id=\"512309b0-e202-417a-88a5-2950b7d4e953\">4<\/sup><\/span><\/p>\n<h2 id=\"c17e2446-4378-4afe-9f59-a10397c4c9b5\" class=\"jrnlHead2\">Inverse (flexural) psoriasis<\/h2>\n<p id=\"22aa2f12-16e3-49bf-9929-9740c4494a3a\" class=\"jrnlSecPara\"><span id=\"eb2a36e7-92a9-43a6-bffc-ec2d9c114724\">Inverse psoriasis, also known as flexural\u00a0<span id=\"840ad004-4cb0-49be-a153-18a4c6ffa0de\">psoriasis<\/span>,\u00a0<\/span>is a variety of psoriasis occurring in the skin folds.<span id=\"604e10fe-6f94-448f-94df-52f2dd955a7f\" class=\"jrnlBibRef\" data-citation-string=\" R56 R57 \"><sup id=\"04c4a684-36f1-4223-9759-9a93fb53b81c\">56,57<\/sup><\/span>\u00a0It is more inflammatory than plaque psoriasis, the most common form of psoriasis, and does not have the characteristic appearance of its traditional counterpart. It may occur along with conventional psoriasis or\u00a0<em id=\"8e59dd0e-7823-4773-a080-69b1278b6e84\">per ipsum<\/em>. The lesions are erythematous plaques, and the lesion sites are similar to erythrasma. However, intense itching and a younger age of onset \u2013 it is more common in children \u2013 help distinguish the two conditions. Furthermore, these lesions do not fluoresce with Wood\u2019s lamp, unlike erythrasma. Nonetheless, superinfection of the disease with fungi and bacteria, including\u00a0<em id=\"bfe7958a-3b0e-4d8c-b5d1-5fbc3c234754\">C. minutissimum<\/em>, may complicate the picture. A primary bacterial infection is postulated to trigger inverse psoriasis; however, it is still unclear whether erythrasma triggers an immune process resulting in psoriasis or, vice versa, it is psoriasis that leads to erythrasma.<span id=\"ae0e9d00-d32b-4474-82f3-2fcb69466c68\" class=\"jrnlBibRef\" data-citation-string=\" R56 R57 \"><sup id=\"065b675d-1123-43d3-a730-51f1c95d6ad2\">56,57<\/sup><\/span><\/p>\n<h2 id=\"0df894b5-2d11-4546-b8b4-bd80a768f6f6\" class=\"jrnlHead2\">Seborrheic dermatitis<\/h2>\n<p id=\"b1078f49-1eb4-49de-aab7-ec207dbd2fd7\" class=\"jrnlSecPara\"><span id=\"696693c1-efcd-44ef-9021-70fb8a952145\">Seborrheic dermatitis<\/span>\u00a0is characterized by erythema, erosions, fissures and yellow crusts.<span id=\"1b67a338-7cb5-499f-8999-c647ef9c7f09\" class=\"jrnlBibRef\" data-citation-string=\" R58 \"><sup id=\"f72e3df8-14d4-483d-81b6-78ae351fb1e2\">58<\/sup><\/span>\u00a0Apart from flexural folds, the face and scalp are characteristic sites of this condition.\u00a0<span id=\"5ee38eb1-f97a-4a08-bcf1-96043024fbfc\">In cases of seborrheic dermatitis<\/span>, Wood\u2019s lamp is negative.<span id=\"54181604-0380-464b-ac0a-a77c23a357bd\" class=\"jrnlBibRef\" data-citation-string=\" R58 \"><sup id=\"6afd694f-89a1-46ac-b0e0-77e9d6db9018\">58<\/sup><\/span><\/p>\n<h1 id=\"5942b399-634c-4052-a2bd-c9fb363ae833\" class=\"jrnlHead1\">Treatment<\/h1>\n<p id=\"94c570f3-03ef-44e6-a782-70aaa4129f0d\" class=\"jrnlSecPara\">There is no consensus about which compound should be used as the initial treatment of\u00a0<span id=\"afc38e40-41e5-4ba1-8b61-79e39fc8eb69\">erythrasma<\/span>. The choice of the initial treatment depends on patient factors as well as the physician&#8217;s preference. The cost of therapy and compliance are also important considerations. In general, oral medications are preferable for treating extensive lesions, and topical medications are preferable for smaller lesions.<span id=\"70e6dd03-7a12-474b-84d3-66ef577f02b2\" class=\"jrnlBibRef\" data-citation-string=\" R59 R60 R61 \"><sup id=\"4a3abfd6-5315-4810-9189-a9549a563960\">59\u201361<\/sup><\/span>\u00a0In some cases, such as in noncompliant patients, a combination of the two modalities may be necessary. However, no real-world studies are available to support this approach. Few studies compare the use of these treatment regimens in\u00a0<span id=\"01c5e94c-b60d-4fca-b267-429c11de739c\">erythrasma<\/span>.<span id=\"1561cabf-c5b7-477e-8480-a0034d8d010a\" class=\"jrnlBibRef\" data-citation-string=\" R62 R63 \"><sup id=\"514c0003-b79a-47dc-8b2e-9770f6fc7b23\">62,63<\/sup><\/span>\u00a0In the past, azole antifungals have been used but are currently not a first-line treatment; however, they are useful when erythrasma is coinfected with fungi.<span id=\"1d868b30-4273-4033-94f5-ef062a92b06a\" class=\"jrnlBibRef\" data-citation-string=\" R64 \"><sup id=\"4d9b4327-001a-45ec-9b2d-a15b726cfb6e\">64<\/sup><\/span>\u00a0<span class=\"jrnlTblRef\" data-citation-string=\" T1 \">Table 1<\/span>\u00a0lists therapies commonly used to treat erythrasma and important considerations for the individual medications.<\/p>\n<div id=\"BLK_T1\" class=\"jrnlTblBlock\">\n<p id=\"T1\" class=\"jrnlTblCaption\"><span id=\"4b5b700b-fce4-4a06-927a-486965212404\" class=\"label\">Table 1:<\/span>Common treatment options for erythrasma<\/p>\n<div class=\"jrnlTblContainer\">\n<table id=\"9e762135-2e5a-404c-bffb-6d8d7e112e86\" class=\"jrnlTable\">\n<thead id=\"60de5a90-620d-4df3-abaa-3a15ff3151ab\">\n<tr id=\"2d694d21-941b-4e33-8c9f-a1cd3dac05b8\">\n<td id=\"e9ef7963-8841-40fd-9f1b-179d9bc4acf8\">\n<p id=\"232567df-c751-4377-a2ad-24c2f02be2a5\" class=\"jrnlTblBody\"><b id=\"823019e0-def3-4251-a6ff-503b4ca762db\">Topical therapy<\/b><\/p>\n<\/td>\n<td id=\"b1733f29-a849-4af2-a08d-b96aae868827\">\n<p id=\"5c40aa3b-d283-43a4-ab1b-eb508096fa6a\" class=\"jrnlTblBody\"><b id=\"57197e2e-c06c-4c50-bb38-67646e8fa9d7\">Considerations<\/b><\/p>\n<\/td>\n<\/tr>\n<\/thead>\n<tbody id=\"8af769bb-0e57-4e48-90e9-19b4dca2d4e8\">\n<tr id=\"183657ec-601f-46aa-981c-ffa09cd89045\">\n<td id=\"760af670-bd2f-4a54-a79b-7ecbea7202e9\" class=\"\">\n<p id=\"523b7fad-9df1-425e-8ba6-c0dbaad96813\" class=\"jrnlTblBody\">Fusidic acid<\/p>\n<\/td>\n<td id=\"05cffa1e-f1c8-45d6-8900-b9975d860407\" class=\"\">\n<p id=\"f4ba5442-8164-481c-9f40-28542edec0c1\" class=\"jrnlTblBody\">2% ointment<\/p>\n<p id=\"be03ba47-7ad1-4bda-99fe-d2c6d12f74b8\" class=\"jrnlTblBody\">2 weeks treatment<\/p>\n<p id=\"86b6ae62-62c6-4e71-9207-c4057d066c7d\" class=\"jrnlTblBody\">Minimal side effects<\/p>\n<p id=\"0cd0e2a5-70be-4651-9cb8-a0e33b3dfad7\" class=\"jrnlTblBody\">Resistance documented<\/p>\n<p id=\"896a1641-29e8-4379-941c-73ceb45bbd6c\" class=\"jrnlTblBody\">Novel drug delivery routes available:<\/p>\n<ul id=\"ed97ad9c-27ff-4141-8212-27ab8bbf8064\">\n<li id=\"ddee46ff-4662-434a-891d-f1288588ef85\">\n<p id=\"c2f2aba0-7fe3-446d-bb10-4961760557dd\" class=\"jrnlListPara\">Liposomal-based delivery systems<\/p>\n<\/li>\n<li id=\"40387299-0a99-451a-803c-5509e1ccac23\">\n<p id=\"714dc8a8-a358-4f91-9041-92c2c6b3f953\" class=\"jrnlListPara\">Niosomal-based delivery systems<\/p>\n<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr id=\"c9b20393-f92f-481e-a47f-32d557fc20d4\">\n<td id=\"4e875e01-3fc0-45d8-8bd5-4fa53f40984c\" class=\"\">\n<p id=\"be35029f-b5b5-4c36-a4ed-8ae02c0c1e52\" class=\"jrnlTblBody\">Clindamycin<\/p>\n<\/td>\n<td id=\"b39cd5b7-805d-4a45-a32e-022b1b2f4d27\" class=\"\">\n<p id=\"211b6a2d-5632-4327-abce-b452a81e674b\" class=\"jrnlTblBody\">2% lotion or ointment<\/p>\n<p id=\"69be389d-5340-4b31-9470-ffdb1127a0c9\" class=\"jrnlTblBody\">2 weeks treatment<\/p>\n<p id=\"efc3c6e6-ceda-4b7d-906e-55474212b57f\" class=\"jrnlTblBody\">Minimal local side effects<\/p>\n<p id=\"ea6281c5-7f16-4262-8cc3-a2d2ec569893\" class=\"jrnlTblBody\">No systemic toxicity<\/p>\n<p id=\"0dca05f2-4183-45ee-bc6c-55fd6fe16871\" class=\"jrnlTblBody\">Resistance reported<\/p>\n<\/td>\n<\/tr>\n<tr id=\"c5476591-f0fa-4d1d-a99d-0b61d8f89bd5\">\n<td id=\"525ddeb1-3178-43de-92f8-203b19ae29ca\" class=\"\">\n<p id=\"a8e6c729-9634-49b2-a23b-3222de5c7d61\" class=\"jrnlTblBody\">Mupirocin<\/p>\n<\/td>\n<td id=\"8043a263-a167-4b59-b359-6d90dee4c769\" class=\"\">\n<p id=\"c631312f-45af-4341-b505-f83fbba1c6eb\" class=\"jrnlTblBody\">2% ointment<\/p>\n<p id=\"9d8df2db-756d-4684-b7c2-303d4ed59b09\" class=\"jrnlTblBody\">2 weeks treatment<\/p>\n<p id=\"7c0612f4-8ae4-41d4-8bfd-7db8e872620d\" class=\"jrnlTblBody\">Minimal local side effects<\/p>\n<p id=\"a86f961a-fe90-4c12-b422-1815eb24c283\" class=\"jrnlTblBody\">No systemic side effects<\/p>\n<\/td>\n<\/tr>\n<tr id=\"9bd7c507-8395-47a6-a9a8-d9ff0118120c\">\n<td id=\"d11c001c-ea72-4944-aa90-dc8550af87e9\" class=\"\">\n<p id=\"5239099e-f84a-41ca-8829-111ed1f6668e\" class=\"jrnlTblBody\">Whitfield ointment<\/p>\n<\/td>\n<td id=\"806d3f8f-2dc9-4922-928e-a9ee8c3e2164\" class=\"\">\n<p id=\"b36f07a6-a519-4530-87f3-18eb11ce82fb\" class=\"jrnlTblBody\">Benzoic acid 6% plus salicylic acid 3% in a petrolatum base<\/p>\n<p id=\"26177052-ac25-4375-a723-f5310d50ceb9\" class=\"jrnlTblBody\">Twice daily application for 2 weeks<\/p>\n<p id=\"2e976a25-ab31-46d7-a611-821783826642\" class=\"jrnlTblBody\">Works mainly by keratolytic effects rather than antibacterial<\/p>\n<p id=\"18d8250f-ae85-404b-9506-934012239bb8\" class=\"jrnlTblBody\">Similar efficacy to systemic erythromycin for axillary or groin lesions<\/p>\n<p id=\"df774422-c9b0-48d8-ab1a-5126e436fd7f\" class=\"jrnlTblBody\">Superior to oral agents for interdigital lesions<\/p>\n<p id=\"9a911b50-fbea-462a-91de-3eeb7eab1c48\" class=\"jrnlTblBody\">Irritation is a minor side effect<\/p>\n<\/td>\n<\/tr>\n<tr id=\"c40fc235-fc71-4d4e-9209-fd08aa159003\">\n<td id=\"d1a61e4b-e37e-4fa8-9350-c917c1e79f18\" class=\"\">\n<p id=\"d0710b71-e61f-45d2-a529-f9393e3101f9\" class=\"jrnlTblBody\">Benzoyl peroxide<\/p>\n<\/td>\n<td id=\"6fc59a0f-baa7-4c26-9d83-9378954d03bd\" class=\"\">\n<p id=\"9241eb42-2af5-4aa0-9ed6-f2bfafe525e8\" class=\"jrnlTblBody\">Highly reactive oxygen radicals destroy bacteria<\/p>\n<p id=\"6c13b75c-b142-4b3c-b57d-8c85f770e649\" class=\"jrnlTblBody\">No formation of bacterial resistance<\/p>\n<p id=\"11a95e3d-9425-424a-9a76-221f99a486ff\" class=\"jrnlTblBody\">Component of antibacterial soaps<\/p>\n<\/td>\n<\/tr>\n<tr id=\"2dc5bda7-1a28-4da4-b32e-1b30d6e1a4a7\">\n<td id=\"295ae16f-fdc8-4b7d-9cea-9a516b567b34\" class=\"\">\n<p id=\"7c9ff344-b31c-4304-9f61-6f674562e8de\" class=\"jrnlTblBody\"><b id=\"849d0b29-65e9-493b-9d3e-ae1fc6cc9db1\">Oral therapy<\/b><\/p>\n<\/td>\n<td id=\"58054d7a-ae48-41bd-836f-ea299a413198\" class=\"\">\n<p id=\"2cb7ee1e-29fe-4c44-b615-745d7c0f4da6\" class=\"jrnlTblBody\">\n<\/td>\n<\/tr>\n<tr id=\"18d6f8ec-b6c6-486e-9c17-0ddfc059c37f\">\n<td id=\"1bef6c71-419a-4c55-84e4-73575a5f0ec9\" class=\"\">\n<p id=\"c78749b3-c47d-4772-8306-a1abd03e3d75\" class=\"jrnlTblBody\">Erythromycin<\/p>\n<\/td>\n<td id=\"7667aa16-60eb-42e3-81eb-f44177f37701\" class=\"\">\n<p id=\"dfd662ba-9893-45bc-afa3-b69e9651becf\" class=\"jrnlTblBody\">250 mg QID for 14 days<\/p>\n<p id=\"33782bac-68d4-4e51-8387-6db06fc9cd50\" class=\"jrnlTblBody\">Minor GI side effects common<\/p>\n<p id=\"45f22a1d-618c-480a-a788-614db6582765\" class=\"jrnlTblBody\">QTc prolongation: caution with p 450 inhibitors<\/p>\n<\/td>\n<\/tr>\n<tr id=\"37b8629c-8dd9-4fa5-9ea9-9525a340699b\">\n<td id=\"4402c423-fdff-4d53-943a-d520e1c5dc90\" class=\"\">\n<p id=\"60cd5cd2-f6e8-44b7-8fe6-5d39e6c34fa2\" class=\"jrnlTblBody\">Clarithromycin<\/p>\n<\/td>\n<td id=\"5a473350-39c1-4e56-9414-aa5a8a35abe9\" class=\"\">\n<p id=\"f5e62305-de5d-4c28-8fe7-9f060696dfd0\" class=\"jrnlTblBody\">1 g single dose<\/p>\n<p id=\"bd9de7d3-05d3-4e52-aa14-b69d167db879\" class=\"jrnlTblBody\">Side effects similar to erythromycin<\/p>\n<\/td>\n<\/tr>\n<tr id=\"c6aeeb06-a64f-417c-a02d-c2d8ba5f0a70\">\n<td id=\"258f1384-0686-481c-99f4-6d4a1e7e2a31\" class=\"\">\n<p id=\"27c3582d-49a4-42ea-a5e0-a3549db21a99\" class=\"jrnlTblBody\">Tetracyclines<\/p>\n<\/td>\n<td id=\"ebd699b2-4540-44d4-82d6-f06e2cafcf6e\" class=\"\">\n<p id=\"3f436cd3-bce7-4154-92af-ed8ced7c3671\" class=\"jrnlTblBody\">250 mg QID for 14 days<\/p>\n<p id=\"06024871-8083-4bc3-8ec1-02ba58d4bf20\" class=\"jrnlTblBody\">Minimal GI side effects<\/p>\n<p id=\"49eadc37-cef5-4f08-be1c-b04a25f7da29\" class=\"jrnlTblBody\">Photosensitivity<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<div id=\"fef9b3bc-1e64-4284-9fd3-8d3255570461\" class=\"jrnlTblFootGroup\">\n<div id=\"T1_FN1\" class=\"jrnlTblFoot\">\n<p class=\"jrnlTblFootText\"><span id=\"56e7852c-b848-44f0-bddb-89d7b71f0306\" class=\"jrnlTblDefItem\">GI = gastrointestinal;\u00a0<\/span><span id=\"cdba0934-ed91-4ef5-a6d8-62f6a8864ec4\" class=\"jrnlTblDefItem\">QID = four times a day.<\/span><\/p>\n<\/div>\n<\/div>\n<\/div>\n<h2 id=\"8390c4c6-fe96-4528-a255-2e17dc4769c9\" class=\"jrnlHead2\">Antibiotic resistance<\/h2>\n<p id=\"93540fe0-502b-47bc-bc71-672bd3d13f58\" class=\"jrnlSecPara\">Widespread antibiotic use encourages the development of resistant bacterial strains. This is also true in the case of\u00a0<em id=\"7ce5a3be-31e5-4311-8207-510bbda5531a\">C. minutissimum<\/em>. Many studies have shown increasing resistance of this bacteria to macrolides, which are the mainstay of therapy against bacterial infection.<span id=\"11882a87-f96c-4af5-b27d-ea79ba778a0d\" class=\"jrnlBibRef\" data-citation-string=\" R65 R66 \"><sup id=\"e2d891d2-e8be-4599-b7db-1a56501bc1f8\">65,66<\/sup><\/span>\u00a0Bacterial genes that promote resistance have been mapped. They are detected by polymerase chain reaction and may guide the choice of therapy in the future. The percentage of patients resistant to various antibiotics varies among different geographic areas and may reflect patterns of use and testing methods. Antibiotic stewardship for use in erythrasma should be in place.<span id=\"fffeb4f7-3bb5-458a-9c21-ccedcadec0a8\" class=\"jrnlBibRef\" data-citation-string=\" R66 \"><sup id=\"534e5156-23df-4da3-b3cc-85dab3232c6c\">66<\/sup><\/span><\/p>\n<h1 id=\"3d8c9778-c96a-464e-95c0-d23e144dc7a2\" class=\"jrnlHead1\">Other novel treatment modalities<\/h1>\n<p id=\"af8dfa8e-89a5-4471-ac65-1e3aaed2a027\" class=\"jrnlSecPara\">In the era of ever-increasing antibiotic drug resistance, some novel treatments that do not share this problem may find a place in the therapeutic armamentarium of erythrasma.<\/p>\n<h2 id=\"bb7c97bd-c280-4b9c-9610-c19ca9db780b\" class=\"jrnlHead2\">Phototherapy<\/h2>\n<p id=\"dafa5b4f-e34d-48f3-a429-b26b04e5c217\" class=\"jrnlSecPara\">Red light activates the pigments produced by\u00a0<em id=\"b9047710-c91c-49d0-9452-e0f12add5800\">C. minutissimum<\/em>, and the resulting photodynamic activation damages the bacteria, causing cell death. In a pioneering study, Darras-Vercambre et al. treated 13 patients with erythrasma with one or two illuminations of red light and found a complete cure in 3 patients and at least a 30% reduction in the remainder.<span id=\"3a3495a8-a5d2-4eb2-a9df-2c0b69e7106d\" class=\"jrnlBibRef\" data-citation-string=\" R67 \"><sup id=\"9ac257e2-a8a2-429e-bbc9-1e1ca6824f0f\">67<\/sup><\/span><\/p>\n<p id=\"4c4549ea-15a2-4c6a-93e4-f8f6d7880631\" class=\"jrnlSecPara\">Zeina et al. used antimicrobial photodynamic therapy on the skin utilizing methylene blue and visible light and studied the effects of light intensity in killing various organisms.<span id=\"529ac6a6-1134-48bb-b243-10c83c56eb33\" class=\"jrnlBibRef\" data-citation-string=\" R68 \"><sup id=\"44634412-02d3-4a6d-bef9-b89c72af2420\">68<\/sup><\/span>\u00a0The list included\u00a0<em id=\"9457d6fa-9128-4104-abe6-29cc8898e2f6\">C. minutissimum<\/em>, which portrayed a D value of 120<span id=\"f1790bfc-52dd-48f9-b519-875fe9478c6a\" class=\"nonBreakingSpace\">\u00a0<\/span>s. A similar response was seen with natural sunlight.<span id=\"76f47264-2fe3-4f43-a7aa-2252bdc34d6a\" class=\"jrnlBibRef\" data-citation-string=\" R68 \"><sup id=\"76695ed0-f05b-44a5-8675-2ad233e78dc0\">68<\/sup><\/span><\/p>\n<h2 id=\"bfa674ff-6648-4127-821f-62cbffd06369\" class=\"jrnlHead2\">Local antiseptics<\/h2>\n<p id=\"b8cd6f9d-9c46-49f5-85e6-dc8afee6f654\" class=\"jrnlSecPara\">Nishioka et al. examined the antibacterial efficacy of olanexidine compared with chlorhexidine and povidone-iodine, two well-known antiseptic agents, on an\u00a0<em id=\"0e450172-52cf-4f26-ba9d-8d840dc22877\">ex vivo<\/em>\u00a0porcine skin model and had good results.<span id=\"4f9f43fc-8a87-4da0-b924-eee5da6bfa07\" class=\"jrnlBibRef\" data-citation-string=\" R69 \"><sup id=\"66c9f0d1-62b2-4659-9b4f-bc98536e20c7\">69<\/sup><\/span>\u00a0If found to be successful in large human trials, this novel method may help prevent recurrences.<\/p>\n<h2 id=\"425a640f-b871-47ef-ac3d-62b94d42b38b\" class=\"jrnlHead2\">Ozonized olive oil<\/h2>\n<p id=\"d5abfd5b-195d-40a0-a46d-2aace0ace9fb\" class=\"jrnlSecPara\"><span id=\"0c7f77c0-42c7-4c93-b275-6fe122392ad8\">Ram\u00edrez-Hobak<\/span>\u00a0et al. studied the local application of ozonized olive oil twice daily for 10 days on 10 patients and found a similar response to oral erythromycin.<span id=\"4ed4ad47-7808-4829-bf6b-68fdf1039e9f\" class=\"jrnlBibRef\" data-citation-string=\" R33 \"><sup id=\"76489286-0833-4b9b-bc7c-b342f208a154\">33<\/sup><\/span>\u00a0The ozone produces bactericidal action via reactive oxygen radicals delivered to bacteria. Drug resistance was not reported. This therapy is yet to be validated in larger trials.<\/p>\n<h2 id=\"9c8ba24e-3478-4f01-90b2-f61990b3a8ba\" class=\"jrnlHead2\">Drug delivery systems<\/h2>\n<p id=\"d25f94b4-93a8-4c97-bf64-9d3323dd1583\" class=\"jrnlSecPara\">Fusidic acid-based topical liposomal gel formulations enhance drug delivery to the skin. Fusidic acid-based niosomal drug delivery systems are more stable than liposomal-based systems. Niosomes are nonionic surfactants and multi-lamellar vesicles created to act as a local drug reservoir that ensures steady, constant volume delivery into the stratum corneum.<span id=\"ad8a7021-c7ca-4e0e-ac3e-c5cabb7256ea\" class=\"jrnlBibRef\" data-citation-string=\" R70 \"><sup id=\"12ccceb7-ac80-4c79-ad82-bc8bec4120d6\">70<\/sup><\/span>\u00a0Furthermore, a polymeric nanoparticle preparation of erythromycin stearate with improved absorption and availability has shown promise.<span id=\"87470ef3-a52e-470a-aa2f-7ffb938398e5\" class=\"jrnlBibRef\" data-citation-string=\" R71 \"><sup id=\"a23cc8fe-e10d-402a-a531-96254c23a998\">71<\/sup><\/span><\/p>\n<h2 id=\"549e3212-f1b4-4535-ac18-5e6942cfeb1f\" class=\"jrnlHead2\">Complementary and alternative medicines<\/h2>\n<p id=\"c9524587-6504-44b1-814a-174e6f3f677a\" class=\"jrnlSecPara\">A number of plant-based compounds used in indigenous systems of medicine are reported to be effective in treating several dermatological conditions, including erythrasma.<span id=\"e475a337-40d3-4dd3-80be-b38365b01471\" class=\"jrnlBibRef\" data-citation-string=\" R72 R73 \"><sup id=\"bc05f35b-ed98-47a2-a658-7be2172e2b3c\">72,73<\/sup><\/span>\u00a0More robust trials are needed to define their role as treatments for this condition.<\/p>\n<h1 id=\"9d973e36-659f-4e68-9507-6e45be4a00e4\" class=\"jrnlHead1\">Prevention of recurrence<\/h1>\n<p id=\"5282614e-9e16-4785-ad8d-682cac462548\" class=\"jrnlSecPara\">To prevent the recurrence of erythrasma, the treated areas must be kept clean by regular washing and implementing other hygiene measures, such as avoiding skin-to-skin contact; not sharing towels, razors, soap or clothes; and not touching wash basin faucets and disposable wipes. Excessive sweating must be prevented with appropriate sweat-absorbing clothing, fans, air conditioning or sweat absorbers. Weight loss, control of diabetes and correction of immunosuppression are other important measures in appropriate patients, such as weight loss in patients who are obese and blood glucose control for those with diabetes. Periodic and meticulous surveillance for the recurrence of erythrasma by patients and physicians is also necessary. The use of antibacterial soaps and early treatment of recurrences are also recommended.<\/p>\n<h1 id=\"66526905-e402-412c-825c-90cf9289b569\" class=\"jrnlHead1\">Future directions<\/h1>\n<p id=\"009d3dc0-5080-43f6-a622-fe4870c60053\" class=\"jrnlSecPara\">A better understanding of the infective process, spread and mechanisms underlying the recurrence of erythrasma and antibiotic resistance will help improve outcomes in erythrasma. The differences in the behaviour of the organism between hosts who are immunocompromised and those who are not immunocompromised will prove resourceful in patients with HIV and for those receiving cytotoxic chemotherapy. Moreover, the novel treatment modalities for the disease discussed earlier need further validation. Finally, practice guidelines for the diagnosis and management of erythrasma and curriculum changes need to be urgently developed to educate internists and subspecialists to enable them to identify and manage this condition.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Article highlights Erythrasma is a common chronic superficial cutaneous bacterial infection caused by Corynebacterium minutissimum when conditions are conducive. Corynebacterium minutissimum produces coproporphyrin III (a phosphor) that emits a coral pink fluorescence under Wood\u2019s lamp and helps confirm the diagnosis of erythrasma. Smears, cultures and biopsies are only needed in a minority of patients with [&hellip;]<\/p>\n","protected":false},"author":77788,"featured_media":4576,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[1],"tags":[],"acf":[],"_links":{"self":[{"href":"https:\/\/touchinfectiousdiseases.com\/wp-json\/wp\/v2\/posts\/14522"}],"collection":[{"href":"https:\/\/touchinfectiousdiseases.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/touchinfectiousdiseases.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/touchinfectiousdiseases.com\/wp-json\/wp\/v2\/users\/77788"}],"replies":[{"embeddable":true,"href":"https:\/\/touchinfectiousdiseases.com\/wp-json\/wp\/v2\/comments?post=14522"}],"version-history":[{"count":13,"href":"https:\/\/touchinfectiousdiseases.com\/wp-json\/wp\/v2\/posts\/14522\/revisions"}],"predecessor-version":[{"id":16287,"href":"https:\/\/touchinfectiousdiseases.com\/wp-json\/wp\/v2\/posts\/14522\/revisions\/16287"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/touchinfectiousdiseases.com\/wp-json\/wp\/v2\/media\/4576"}],"wp:attachment":[{"href":"https:\/\/touchinfectiousdiseases.com\/wp-json\/wp\/v2\/media?parent=14522"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/touchinfectiousdiseases.com\/wp-json\/wp\/v2\/categories?post=14522"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/touchinfectiousdiseases.com\/wp-json\/wp\/v2\/tags?post=14522"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}