Erytrasma.ppt

ERYTHRASMA

DERMATOVENEROLOGY DEPARTMENT MEDICAL FACULTY UKRIDA UNIVERSITY

KUDUS, 1-9-2014

Supervisor:

INTRODUCTION

Definition:

Erythrasma is a common superficial bacterial

infection of the skin characterized by well-difened but

irregular reddish brown patches, occuring in the

intertriginous areas, or by fissuring and white maceration in

the toe clefts.

EPIDEMIOLOGY

1. The incidence of erythrasma is reported to be around 4%

2. The widespread form is found more frequently in the

subtropical and tropical areas

3. The incidence of erythrasma increases with age and higher in black people

4. Men and women are equally affected; the

crural form is more common in men and the

interdigital form is more common in women (83%

of 24 patients).

ETIOLOGY

PATHOGENESIS

CLINICAL MANIFESTATION

Figure 1. A. Sharply marginated, red patch in the axilla.B. This macerated interdigital web-space.

A B

DIAGNOSIS

1. Anamnesis

:

DIAGNOSIS

2. Physical examination:

DIAGNOSIS

3. Laboratory examinations:

a. Wood Lamp: Characteristic coral-red fluorescence (attributed

to coproporphyrin III). May not be present if patient has

bathed recently.

Figure 2. A. Coral-red fluoresence of interdigital lesion B. Coral-red fluoresence of inguinal (crural) lesion

DIAGNOSIS

b. Direct Microscopy: Negative

for fungal forms on KOH

preparation of skin scraping.

Figure 4. KOH preparation of skin scraping show fine filaments of Corynebacterium minutissimum.

c. Bacterial Culture:

Heavy growth of

Corynebacterium.

Rules out Staphylococcus aureus,

group A or group B

Streptococcus, and Candida

infection.

Pseudomonas aeruginosa

webspace infection (feet) is also

present.

DIFFERENTIAL DIAGNOSIS

1. Pityriasis versicolor

Figure 5.

A. Pityriasis versicolor: These

lesion are darker

(hyperemia secondary

inflammatory response and

increased melanin).

B. Spaghetti and meatballs

appearence of Malassezia

in KOH preparation.

A

B

DIFFERENTIAL DIAGNOSIS

Figure 6.

2.Tinea Cruris: Blotchy

erythema with areas of

atrophy and scale on the right

medial upper thigh

boerdering the inguinal area.

3.Tinea Pedis (interdigital

type): Hyperkeratotic and

macerated (hydration of the

stratum corneum).

2.

3.

Tinea Pedis (interdigital

type)Tinea Cruris

Pityriasis Versicolor

Site of Predilection

Most: between fourth and fifth toes

Groins and thighs, may extend to buttocks

Upper trunk, upper arms, neck, abdomen, axillae, groins, thighs, genitalia

Wood Lamp Yellow-green Yellow-green

Blue-green (yellowish white or copper-orange)

Direct microscopy

+ (septated hyphae and spora)

+ (septated hyphae and spora)

Spagetthi and meatballs apperance

CultureDermatophytes can be isolated

Dermatophytes can be isolated

Malassezia furfur

TREATMENT

1. Prevention/Prophylaxis: Wash with benzoyl

peroxide. Medicated powders. Topical antiseptic alcohol

gels: isopropyl, ethanol.

2. Topical Therapy: Preferable. Benzoyl peroxide (2,5 %) gel daily, after showering, for 7

days Topical erythromycin or clindamycin solution twice daily

for 7 days Sodium fusidate ointment, mupirocin ointment or cream Benzoic acid cream (6%) and salicylic acid cream (3%) Topical antifungal agents: clotrimazole, miconazole,

econazole, or ketoconazole (2%)

TREATMENT

3. Systemic Antibiotic Therapy:

Erythromycin:

Children: 30-50 mg/kgBW/day 7-10 days

Adult: 4 x 250 mg/day 2-3 weeks

Clarithromycin: 1 gram single dose

Tetracylin: 250 mg for 7 days

COMPLICATION & PROGNOSIS