AMMAR ABDURRAHMAN HASYIMC111 08 302

NURJANNAH S. TOEKANC111 08 286ERYTHRASMADERMATOVENEROLOGY DEPARTMENT MEDICAL FACULTY HASANUDDIN UNIVERSITY

MAKASSAR, AUGUST 2012Advisor:

dr. A. Rohayati Darma Mufti

Supervisor:

dr. Sitti Nur Rahmah, Sp.KK.

INTRODUCTIONDefinition: 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.

EPIDEMIOLOGY1. The incidence of erythrasma is reported to be around 4%2. The widespread form is found more frequently in the subtropical and tropical areas3. The incidence of erythrasma increases with age and higher in black people4. 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.

DIAGNOSISAnamnesis :

DIAGNOSISPhysical examination:

DIAGNOSISLaboratory examinations: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

DIAGNOSISDirect Microscopy: Negative for fungal forms on KOH preparation of skin scraping.

Figure 4. KOH preparation of skin scraping show fine filaments of Corynebacterium minutissimum.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 DIAGNOSISPityriasis versicolorFigure 5. Pityriasis versicolor: These lesion are darker (hyperemia secondary inflammatory response and increased melanin).Spaghetti and meatballs appearence of Malassezia in KOH preparation.AB

DIFFERENTIAL DIAGNOSISFigure 6. Tinea Cruris: Blotchy erythema with areas of atrophy and scale on the right medial upper thigh boerdering the inguinal area.Tinea Pedis (interdigital type): Hyperkeratotic and macerated (hydration of the stratum corneum).2.3.

Tinea Pedis (interdigital type)Tinea CrurisPityriasis VersicolorSite of PredilectionMost: between fourth and fifth toesGroins and thighs, may extend to buttocksUpper trunk, upper arms, neck, abdomen, axillae, groins, thighs, genitaliaWood LampYellow-greenYellow-greenBlue-green (yellowish white or copper-orange)Direct microscopy+ (septated hyphae and spora) + (septated hyphae and spora)Spagetthi and meatballs apperanceCultureDermatophytes can be isolatedDermatophytes can be isolatedMalassezia furfur

TREATMENTPrevention/Prophylaxis: Wash with benzoyl peroxide. Medicated powders. Topical antiseptic alcohol gels: isopropyl, ethanol.

Topical Therapy: Preferable. Benzoyl peroxide (2,5 %) gel daily, after showering, for 7 daysTopical erythromycin or clindamycin solution twice daily for 7 daysSodium fusidate ointment, mupirocin ointment or creamBenzoic acid cream (6%) and salicylic acid cream (3%) Topical antifungal agents: clotrimazole, miconazole, econazole, or ketoconazole (2%)

TREATMENTSystemic Antibiotic Therapy: Erythromycin: Children: 30-50 mg/kgBW/day 7-10 daysAdult: 4 x 250 mg/day 2-3 weeksClarithromycin: 1 gram single doseTetracylin: 250 mg for 7 days

COMPLICATION & PROGNOSIS

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