Axillary and inguinal erythrasma - CMAJ

A 50-year-old man presented to the dermatology department with a 1-year history of itchy axillary and groin lesions. He had been treated with a topical antifungal preparation (cyclopyroxolamin), without improvement, by his family physician, who had suspected fungal intertrigo. On physical examination, we observed well-circumscribed, erythematous, brownish, scaly plaques affecting both armpits and the groin area bilaterally (Figure 1). To rule out superficial mycoses, we examined skin scrapings from the infected site under direct microscopy after potassium hydroxide preparation. We did not find any signs of fungal infection and did not isolate any dermatophytes in Sabouraud agar.

Photographs of a 50-year-old man showing erythematous, brownish scaly plaques affecting (A) groin and (B) armpit.
" data-icon-position data-hide-link-title="0">Figure 1:
Figure 1:

Photographs of a 50-year-old man showing erythematous, brownish scaly plaques affecting (A) groin and (B) armpit.

We suspected bacterial infection. Evaluated under Wood's lamp, the lesions exhibited coralred fluorescence (Figure 2). Gram staining confirmed erythrasma, showing clusters of bacilli in epithelial cells; Corynebacterium minutissimum was isolated in culture. We prescribed topical application of erythromycin gel twice a day, and the skin lesions resolved in 2 weeks.

Photographs of (A) groin and (B) axillary lesions showing coral-red fluorescence under Wood's lamp.
" data-icon-position data-hide-link-title="0">Figure 2:
Figure 2:

Photographs of (A) groin and (B) axillary lesions showing coral-red fluorescence under Wood's lamp.

Erythrasma is a superficial infection caused by Corynebacterium minutissimum. Although it is more frequent in tropical regions, it may be seen in temperate areas in older patients, patients who are obese or patients with diabetes.1 Erythrasma typically presents as red-brown macules that coalesce into larger patches, and can be confused with superficial mycoses. Absence of satellite papulopustules is suggestive of erythrasma.2 Examination using Wood's lamp facilitates rapid diagnosis because of the characteristic coral-red fluorescence from coproporphyrin III, produced by the bacteria.2,3 Propionibacterium acnes may produce a similar colour, and Pseudomonas species fluoresce green.2 Recent bathing can temporarily wash away the porphyrins, leading to a negative exam under Wood's lamp.3 To confirm the diagnosis, direct microscopy using potassium hydroxide, Gram stain and culture can be used together to differentiate fungal and Corynebacterium minutissimum infection.1 Treatment for erythrasma is erythromycin, either applied topically twice daily until resolution, or 250 mg taken orally 4 times daily for 2 weeks.1,2

Footnotes

  • Competing interests: None declared.

  • This article has been peer reviewed.

  • The authors have obtained patient consent.

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/

Adblock test (Why?)

Comments

Post a Comment

Popular posts from this blog

What does herpes look like: Pictures, treatment, and prevention - Medical News Today

Image
Herpes sores can affect many areas of the body, including the mouth, genitals, and eyes. Herpes sores look like blisters filled with fluid, which can break open a crust before healing. Herpes is usually a mild condition that causes small sores to appear on the skin. People develop herpes after exposure to the herpes simplex virus (HSV). There are two types of this virus: herpes simplex 1 (HSV-1), or oral herpes, which usually affects the mouth herpes simplex 2 (HSV-2), or genital herpes, which generally affects the genitals Both HSV-1 and HSV-2 can occur on the face or the genitals. People can encounter both herpes viruses through bodily fluids, including genital fluids and saliva. Once someone has the virus, the symptoms can flare up from time to time for the rest of their life. While the sores can be uncomfortable and even painful, they are not usually dangerous for otherwise healthy adults. This article will explain what herpes is, how people get it, and what herpes looks like with ...
Read more