erytrasma.ppt
TRANSCRIPT
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