A Brilliant Case of Erythrasma

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     A 61-year-old man presented with a reddish brown rash in his groin; he had had the rash for more than 30 years and described it as mildly pruritic. After the rash had failed to clear with the use of numerous prescription and over-the-counter antifungal agents, topical corticosteroid preparations of various strengths, emollients, and home remedies, the patient finally attributed the condition to staining of his skin from dark-colored underclothes. Physical examination revealed a diffuse, brownish, scaly plaque in bilateral intracrural areas of his groin, with well-demarcated sparing of the occluded portions of the intertriginous creases (Panel A). The plaque did not have a definitive raised erythematous border with central clearing. A potassium hydroxide preparation of scrapings was negative for fungal elements. Illumination of the plaque with a Wood's lamp, which emits ultraviolet A radiation, revealed a brilliant, coral-red fluorescence, characteristic of the porphyrin pigments produced by Corynebacterium minutissimum in erythrasma (Panel B). The plaque cleared readily with twice-daily application of a topical gel containing 2 percent erythromycin.

    Scott D. Miller, M.D.

    Waccamaw Dermatology

    Myrtle Beach, SC 29572

    Kathleen David-Bajar, M.D.

    Brooke Army Medical Center

    Fort Sam Houston, TX 78234-6000

    http://www.100md.com/html/DirDu/2006/11/29/30/68/65.htm