Erythrasma is a disease of the skin resulting from a bacterial infection with pathogens of the type Corynebacterium minutissimum, which is relatively common with a prevalence of 5 to 10 percent. Men in particular are affected by erythrasma with a chronic course.
What is erythrasma?
Erythrasma (also known as Baerensprung’s disease) is a superficial skin disease caused by a bacterial infection with Corynebacterium minutissimum. Symptomatically, erythrasma manifests itself primarily by smooth, sharply demarcated reddish discolorations of the skin, which become larger within several weeks, possibly confluent (coalesce) and develop a finely lamellar scaling and yellowish-brown discoloration (milk coffee). In particular, the intertriginous skin areas (skin folds) such as armpits, groin as well as perianal and submammary (under the breast) areas are affected by erythrasma, as there is increased perspiration and impairment of the acid balance of the skin in these areas. Another characteristic feature of erythrasma is symmetrical foci on the thighs in the scrotum area. In all cases, erythrasma occurs without itching and may have an asymptomatic course in many cases.
Causes
Erythrasma manifests as a result of bacterial infection with the gram-positive, saprophytic Corynebacterium minutissimum. The pathogen is also found on healthy skin along with dermatophytes and Candida albicans as a component of the normal skin environment. If the environmental conditions are favorable for the pathogen as a result of a disturbed skin flora due to increased perspiration (moisture) or heat development, it can multiply and infect the skin cells and the intercellular space of the stratum corneum (uppermost epidermal layer). The metabolic activity of the bacteria causes dissolution of keratin, the main component of the stratum corneum, resulting in the characteristic skin changes. In addition, hyperhidrosis (abnormal sweating), diabetes mellitus, obesity, and immunosuppressive therapy (e.g., in HIV infection) and tight-fitting clothing are predisposing factors for erythrasma.
Symptoms, complaints, and signs
In the case of erythrasma, the affected person primarily suffers from various skin complaints. These have a very negative effect on the aesthetics of the affected person and limit them significantly. In many cases, this also leads to depression or inferiority complexes and reduced self-esteem. The affected persons do not feel comfortable with their appearance. Due to the strong and extensive redness, this can lead to bullying or teasing, especially in children, so that they also suffer from psychological complaints. The skin itself scales and changes color. In the genital area, erythrasma can also be associated with pain or itching and thus have a very negative effect on the quality of life of the person affected. The disease often spreads to the neighboring regions and causes redness and itching there as well. As a rule, other skin complaints occur simultaneously with erythrasma, so that the affected person may also suffer from dermatitis. However, life expectancy is not negatively affected by the disease. With a simple therapy, the complaints can be relatively well alleviated and limited.
Diagnosis and course
Erythrasma is diagnosed on the basis of the characteristic skin changes. With the aid of a so-called Wood lamp (UV or black light), pigmentary changes and the fluorescent pathogen foci on the skin, which fluoresce bright red or coral in UV light due to the porphyrin they produce, can be made visible. Similarly, gram-positive pathogens can be detected microscopically by Gram staining (blue staining of the bacteria). Differential diagnosis requires differentiation from similar and equally common skin diseases such as cutaneous candidiasis, psoriasis, contact dermatitis, seborrheic dermatitis and tinea. In addition, trichomycosis palmellina and keratolysis sulcata may also be caused by corynebacteria. Erythrasma represents a harmless infectious disease, but it often has a chronic course in men and conditions such as hyperhidrosis or diabetes mellitus.
When should you go to the doctor?
If extensive skin redness and other symptoms of erythrasma are noticed, a physician should be consulted. If scales have already formed, it is best to seek medical advice immediately. The same applies to severe symptoms such as itching or pain in the genital area and under the armpits. If these symptoms are noticed, there is definitely a serious skin disease at the root. Only a dermatologist can determine whether this is erythrasma. People who suffer from hyperhidrosis, diabetes mellitus or obesity are particularly at risk. Increased perspiration or skin flora that is disturbed in some other way are also risk factors that require rapid clarification. If complications arise during the course of treatment, the responsible physician must be informed. In general, the therapy should be well monitored in order to be able to recognize and treat any subsequent complaints at an early stage. In addition to the general practitioner or dermatologist, erythrasma can also be seen by an internist. If the symptoms are severe, a visit to the clinic is indicated.
Treatment and therapy
Therapeutic measures for erythrasma include local therapy of the affected skin areas with ointments or creams containing imidazole, miconazole, or fusidic acid, or solutions containing erythromycin. These substances dry the locally treated skin areas and at the same time have an antimicrobial effect. In addition, a combination of acetylsalicylic acid (ASA) and benzoic acid may be considered. In more severe or persistent courses, systemic therapy with erythromycin (250g four times daily) for a period of fourteen days may be indicated. Due to high patient compliance (therapy adherence), a single therapy with clarithromycin (1000mg) may also be considered. In the context of photodynamic therapy measures, which represent an alternative to pharmacological approaches, red light treatment can be applied. In the case of erythrasma, consistent body hygiene is also an important part of the therapy. For this purpose, the use of acidic soaps or synthetic detergents (syndets or synthetically produced washing-active substances) is recommended to stabilize the skin flora, while moisture and greasy creams and ointments should be avoided. The affected skin areas should generally be kept as dry as possible in the case of erythrasma (e.g. by thorough drying after bathing and showering). In patients with obesity, more pronounced skin folds (especially under the breasts and in the groin) can be protected from moisture with the help of inserted gauze compresses, linen cloths and/or moisture-repellent powders. In addition, to prevent increased perspiration from erythrasma, air-permeable or breathable clothing should be worn.
Outlook and prognosis
The prognosis of erythrasma is favorable in most patients. The changes in skin appearance are readily treatable with available medical options. With the administration of medications, significant improvements in skin appearance usually occur within a few days. The abnormalities gradually disappear until the patient is free of symptoms after about two weeks. If complications occur, the prognosis worsens. If the course of the disease is unfavorable, chronic erythrasma develops. Men in particular belong to the risk group for this development. To improve the prognosis, the affected person can independently take various measures. The skin should be kept dry and clothing should not be worn too close to the body. In this regard, the choice of clothing is crucial for alleviating the symptoms. In addition, excess weight should be avoided, as irregularities in the skin’s appearance often develop in the folds of the skin. As soon as the patient on his own responsibility pays more attention to the care of the skin and the perspiration on the body, the skin flora can be brought into balance. The improvement of the skin flora leads to recovery. Despite the favorable prognosis, recurrence can occur at any time during life. Erythrasma may form again. The prognosis is also favorable if recurrence occurs.
Prevention
Prophylactically, an antimicrobial therapeutic agent can be applied locally once or twice monthly for erythrasma prone to recurrence. In addition, predilection sites (preferentially infested areas) should be kept dry and breathable clothing should be worn.Avoiding obesity through exercise may also prevent erythrasma.
Follow-up
As a rule, the early detection and rapid treatment of erythrasma is the main priority in order to prevent further complications or other complaints. The earlier the erythrasma is detected in this process, the better is usually the further course of this complaint. As a rule, this disease does not reduce the life expectancy of the affected person. The treatment is carried out with the help of medication. These should be taken exactly according to the doctor’s instructions in order to alleviate the symptoms quickly and permanently. In cases of doubt or other ambiguities, a doctor should always be consulted. If the symptoms of erythrasma do not disappear after fourteen days, a doctor must usually be consulted again. Ointments or creams can also be used to alleviate the symptoms. Since the symptoms of the disease can also lead to psychological upsets or depression, psychotic treatment is also useful. Intensive discussions with friends or family can also have a positive effect on the course of the disease. To prevent a recurrence of erythrasma, the underlying disease should also be analyzed in the process.
What you can do yourself
Erythrasma is a harmless bacterial infection, but it can easily become chronic. Affected persons should therefore consult a dermatologist promptly. This is especially true for high-risk patients. These include people who suffer from diabetes mellitus or are very overweight and patients with a weak immune system. Successful therapy always requires the cooperation of the patient. A high degree of personal hygiene is important. The affected areas must be cleaned regularly. It is best to use a slightly acidic cleanser to stabilize the skin environment. In addition, it is important to keep the skin dry. After bathing or showering, the body must be dried completely with a fresh, clean towel. Heavy sweating is one of the causes of the disease and should be avoided. If this is not possible, such as during sports, a shower must be taken promptly and the body then rubbed dry. In people who suffer from severe obesity, the disease often affects the folds of the skin, as these are particularly warm and moist. To keep these areas dry, either gauze bandages can be inserted or a body powder can be applied several times a day. For some sufferers, both measures may be indicated at the same time. In addition, tight-fitting clothing should be avoided and mainly loose-fitting, breathable textiles should be worn.
