Erythrasma in women and men

Erythrasma is a chronic skin disease characterized by spots on the skin, usually in folds such as the armpits, between the fingers, under the breasts, in the groin area and between the buttocks. The disease usually appears as red or brown patches that can be very itchy and scaly. [1]

Epidemiology

Erythrasma is a fairly common dermatologic disease, especially in warm and humid climates. This disease is most commonly seen in adults and the elderly. [2] Several factors associated with the epidemiology of this disease include:

1. Climatic conditions: Erythrasma is more common in warm and humid climates, where sweat and moisture can promote the growth of Corynebacterium minutissimum bacteria.
2. Gender and age: Men and women can be affected, but it is more common in adult men and the elderly.
3. Hygiene: Poor hygiene, especially in skin folds, can contribute to the development of erythrasma.
4. Risk Factors: Risk factors such as obesity, diabetes, and a weakened immune system can increase the likelihood of developing this disease.
5. Trauma and friction: Repeated skin friction or trauma in certain areas may promote infection with Corynebacterium minutissimum bacteria.

Causes of the erythrasma

Erythrasma is caused by the bacterium Corynebacterium minutissimum. This bacterium is a normal component of the human skin microflora and usually does not cause disease. However, under certain conditions and risk factors, it can multiply and cause erythrasma. The main causes and risk factors that contribute to the development of this disease include:

1. Heat and Humidity: Erythrasma is most common in warm and humid climates or where the skin is exposed to prolonged sweat.
2. Poor hygiene: Poor hygiene, especially in the folds of the skin, can promote the growth of bacteria.
3. Obesity: Excess weight can create a favorable environment for the development of erythrasma in the skin folds.
4. Diabetes: People with diabetes have an increased risk of developing erythrasma.
5. Age: The disease is more common in adults and the elderly.
6. Weak immune system: People with weakened immune systems, such as those with other medical conditions or taking certain medications, may have a higher risk of developing erythrasma.
7. Trauma and friction: Repeated skin friction or trauma in certain areas may contribute to the development of infection with the bacterium Corynebacterium minutissimum.

These factors can increase the likelihood of developing the disease, but given the right conditions and even without the presence of risk factors, the bacterium Corynebacterium minutissimum can cause disease. [3]

Pathogenesis

The pathogenesis of erythrasma is related to the bacterium Corynebacterium minutissimum, which plays a key role in the development of this disease. Here are the main steps in the pathogenesis of erythrasma:

1. Skin colonization: The bacterium Corynebacterium minutissimum colonizes the upper layer of the skin, especially in areas of high moisture and heat, such as between the toes, under the breasts, in the folds of the abdomen and inner thighs.
2. Toxin release: Bacteria produce various toxins and pathogenicity factors that cause skin irritation and inflammation.
3. Symptom development: As a result of toxins and bacterial activity, symptoms of erythrasma develop on the skin. This may include the appearance of characteristic spots, usually pink or red in color, with pronounced borders.
4. Spread: If treatment is not started, the infection can spread and worsen, affecting large areas of skin.

Pathogenesis is related to microbiologic and immunologic processes in the skin. The bacteria Corynebacterium minutissimum create the conditions for inflammation and skin changes that lead to the characteristic symptoms of this disease. [4]

Symptoms of the erythrasma

1. Skin patches: One of the most characteristic signs of erythrasma is skin patches. They are usually pink or red in color and can be small or large depending on the extent of the lesion.
2. Well-defined borders: The spots usually have well-defined borders, which distinguishes erythrasma from other skin diseases.
3. Flaking: The skin may be flaky in the affected areas.
4. Itching: Some patients may experience itching and discomfort in the area of the affected skin.
5. Localization: Erythrasma is most commonly found in skin folds such as between the toes, in the armpits, under the breasts, in the abdominal folds, inner thighs, and groin area. However, it can also occur in other areas of the skin. [5], [6]
6. Absence of bullae: An important sign is the absence of blisters or blisters, which are characteristic of other skin diseases such as seborrheic dermatitis or psoriasis.
7. No external crust: Unlike fungal infections, erythrasma is not accompanied by the formation of an external crust.

Forms

There are several forms of this disease:

1. Flat erythrasma: This form of erythrasma appears as flat, pink or red patches on the skin that usually have well-defined borders. They may be small or spread over large areas of skin. Flat erythrasma often occurs in areas where skin folds touch, such as between the toes, in the armpits, under the breasts, and in the abdominal folds.
2. Scarring Erythrasma: In this form of the disease, skin pigmentation becomes more intense and the patches may turn brown. Scarring erythrasma can develop after unsuccessful treatment attempts or when the disease recurs.
3. Erythrasma of the folds: This form is characterized by skin folds such as between the buttocks, under the arms and in the groin area. Symptoms include itching, burning and redness of the skin.
4. Erythrasma of the feet: Lesions on the area of the feet, especially between the toes, may also be called "erythrasma of the feet". It can be a symptom of erythrasma.

Confirmation of the form of erythrasma and prescription of treatment should be made by a dermatologist based on the clinical picture and diagnostic results.

Complications and consequences

Erythrasma is usually not a serious condition and rarely leads to complications. However, if left untreated, it can cause the following problems or complications:

1. Spread of the infection: If treatment is not started, the infection can spread to other areas of the skin and become more widespread.
2. Recurrence: Erythrasma may return after treatment, especially if preventive and hygienic measures are not followed.
3. Itching and discomfort: Itching, irritation and discomfort can accompany erythrasma and they can lead to discomfort.
4. Self-infection: Excessive scratching of affected skin areas can lead to self-infection and worsen the condition.
5. Social and psychological aspects: In the case of visible rashes on exposed skin, erythrasma may affect the patient's self-esteem and psychosocial well-being.

Diagnostics of the erythrasma

Diagnosis of erythrasma is based on clinical signs and may include the following steps:

1. Physical examination: A doctor examines the affected areas of the skin. Erythrasma usually has characteristic symptoms such as red patches with clear borders and flaking.
2. Interview and history: The doctor may ask questions about symptoms, how long they have been present, the location of the rash, and other factors that might help in making a diagnosis.
3. Laboratory tests: Sometimes it may be necessary to take skin samples from the affected areas for laboratory tests such as microscopy. This can help rule out other skin diseases with similar symptoms.
4. Dermatoscopy: This method is used to look at the affected skin in more detail using a special device called a dermatoscope. It can help you see additional details and features of the affected skin.

It is important to see a qualified dermatologist to confirm the diagnosis and choose the best treatment method.

Differential diagnosis

The differential diagnosis of erythrasma is made to rule out other skin conditions with similar symptoms. Here are a few conditions that may have similar symptoms and require differentiation:

1. Psoriasis: Psoriatic rashes can also be red and flaky. However, they usually have more pronounced papules and platysmal areas.
2. Dermatophytoses: Fungal infections such as dermatophytoses can cause skin rashes that may resemble erythrasma. Culture tests can help in diagnosis.
3. Pyoderma: Skin infections caused by bacterial pathogens such as staphylococci or streptococci can have similar symptoms.
4. Allergic contact dermatitis: Contact with irritants, such as chemicals or allergens, can cause similar symptoms. This type of dermatitis requires allergy testing for diagnosis.
5. Eczema: Atopic eczema can also result in red, inflamed areas of skin with flaking and itching.

Treatment of the erythrasma

Treatment for erythrasma usually involves the use of antimicrobial medications and good hygiene practices. Here are the basic steps for treating erythrasma:

1. Antimicrobials: Erythrasma is caused by the bacterium Corynebacterium minutissimum. Antimicrobials are usually prescribed to treat it. Here are some of the antibiotics that can be used for this condition:

• Erythromycin: This is one of the most commonly used antibiotics in the treatment of erythrasma. It can be applied in the form of topical creams or gels, as well as in the form of oral (ingestion) preparations.
• Clarithromycin: This antibiotic is also effective against the bacteria that causes erythrasma.
• Azithromycin: This antibiotic has a long-lasting effect and can be used in a course of treatment.

To determine the most appropriate antibiotic and treatment regimen, you should consult a physician who will diagnose and prescribe the appropriate antibiotic according to the type of infection and the individual characteristics of the patient. [7]

1. Supportive measures: In addition to the use of antimicrobials, it is important to follow the following measures:

• Wash the affected areas of the skin regularly using mild soap.
• Wipe skin thoroughly after showering or bathing.
• Avoid rubbing the skin and rub with a soft towel.
• Avoid tight and synthetic clothing, cotton clothing is preferred.
• Disinfect personal items and linens that may have come in contact with affected skin.

3. Sequence of medication: It is important to follow your doctor's instructions regarding the duration and regimen of antimicrobials. Interrupting treatment may lead to a relapse.
4. Physician follow-up: The physician will monitor the progress of treatment and adjust therapy if necessary.

Because erythrasma can mimic other skin conditions, it is important to diagnose it correctly and choose the appropriate treatment.

Folk treatments can be used as an adjunct to mainstream medical treatment, but do not replace antibiotics, which are the primary way to control erythrasma. Folk methods can help alleviate symptoms and speed up the healing process. Here are some folk remedies that can be used for erythrasma:

1. Application of therapeutic ointments: Ointments based on natural ingredients such as aloe vera, tea tree oil or pine tree oil can be used to soothe and relieve itching. Apply the ointment to the affected areas of the skin several times a day.
2. Herbal baths: Adding herbs to your bath water can help reduce itching and inflammation. Try adding decoctions of herbs such as chamomile, sage, or oak bark to your bath.
3. Treatment of the affected area: Mix water and vinegar in equal proportions and use this solution to treat the affected skin. Hydrogen peroxide solution (3%) can also be used for treatment.
4. Herbal wraps: Make a decoction of herbs such as chamomile, yarrow or sage and use it to wrap the affected areas of the skin. Keep the skin clean and dry.
5. Good nutrition: A balanced diet rich in vitamins and minerals helps strengthen the immune system and promotes quick recovery. Avoid spicy, acidic and fatty foods.
6. Hygiene measures: Regular washing and drying of the affected skin will help prevent the spread of infection.
7. Personal hygiene: Periodic changes of bedding and clothing, as well as body cleanliness, contribute to a quick recovery.

Remember that folk methods do not replace consultation with a doctor and the use of antibiotics, if prescribed.

Prevention

Erythrasma prevention includes the following precautions and hygiene practices:

1. Maintain good skin hygiene: Wash regularly with mild soap and water. Dry your skin thoroughly after showering or bathing.
2. Avoid tight and synthetic clothing: It is preferable to wear cotton clothing that allows the skin to breathe. This will help prevent moisture and sweat from accumulating on the skin.
3. Do not share personal items: Avoid sharing personal items such as towels, underwear, clothing, and personal hygiene items. This will help prevent the transfer of bacteria from one person to another.
4. Disinfect your shoes: If you suspect you or a family member has erythrasma, disinfect your shoes regularly, especially those you wear without socks.
5. See a dermatologist: If you or a family member has had a case of erythrasma, see a dermatologist for proper diagnosis and treatment. Your doctor can also offer recommendations for preventing recurrences.
6. Follow your doctor's advice: If you have been diagnosed with erythrasma and have received treatment, it is important to follow your doctor's instructions about taking antimicrobial medications and maintain personal hygiene practices.

Following good hygiene practices and precautions helps to reduce the risk of developing the disease and prevent it from being passed on to others.

Forecast

The prognosis of erythrasma is usually favorable with timely and proper treatment. Under the influence of antimicrobial drugs such as antibiotics, the bacteria are destroyed and the symptoms of the infection begin to disappear.

If erythrasma is not treated, or if treatment is not effective enough, the infection can progress and lead to more serious complications. In some cases, it can become chronic and return periodically.

It is important to see a doctor at the first signs of the disease and follow the recommendations for treatment and prevention. With the right approach and adherence to medical recommendations, the prognosis of erythrasma is usually good and most patients make a full recovery.

Books on Erythrasma

1. "Dermatology: Illustrated Study Guide and Comprehensive Board Review" - by Sima Jain, Thomas S. McCormack, and Margaret A. Bobonich (2012).
2. "Fitzpatrick's Dermatology in General Medicine" - by Lowell A. Goldsmith, Stephen I. Katz, Barbara A. Gilchrest, Amy S. Paller, David J. Leffell, and Klaus Wolff (2019).
3. "Clinical Dermatology: A Color Guide to Diagnosis and Therapy" by Thomas P. Habif (2020).
4. "Dermatology: An Illustrated Color Text" by David J. Gawkrodger and Michael R. Ardern-Jones (2017).
5. "Textbook of Dermatology, Venereology, and Leprology" by S. Sacchidanand and Aparna Palit (2019).

Literature used

• Butov, Y. S. Dermatovenerology. National guide. Brief edition / edited by Y. S. Butov, Y. K. Skripkin, O. L. Ivanov. - Moscow : GEOTAR-Media, 2020.
• Clinical Guidelines. Erythrasma (Adults, Children) 2023. Latest revision
• Skin diseases. Diagnosis and treatment. Atlas and manual. Conrad Bork, Wolfgang Breuninger. 2005