Erytrasma

Klinika

Popis

• Commonly is asymptomatic, but it can be pruritic [1]
• červenohnědé nesvědivé skvrny až plochy [2]
• Suché, hnědé, ostře ohraničené makuly s mírným šupením [3]
• Lichenification and hyperpigmentation are common [1]
• Occasionally has a wrinkled appearance with scales [1]
• KOH test results are negative [1]

Lokalizace

• V místech vystavených zvýšenému pocení a tření [2]
• Obv. v tříslech (vnitřní strany stehen a šourek) [2]
• V tříslech, axile a interdigitálně [3]
• Inner thighs, crural region, scrotum, and toe webs [1]
• Toe web lesions appear as maceration
• Fourth interdigital space most frequently affected [1]
• Axillae, submammary area, periumbilical region, and intergluteal fold less [1]

Vyvolavatel

• Corynebacterium minutissimum [1]
• Usually as a normal human skin inhabitant [1]
• Lipophilic
• Gram-positive filamentous rods
• Non–spore-forming
• Aerobic
• Catalase-positive
• Diphtheroid
• Ferments glucose, dextrose, sucrose, maltose, and mannitol [1]
• In 20% fetal bovine serum, 2% agar, 78% tissue culture medium
• Nonhemolytic [1]
• 1- to 1.5-mm smooth colonies [1]
• Corynebacterium afermentans [1]

Patofyziologie

• Upper third of the stratum corneum
• Stratum corneum is thickened [1]
• Intercellular spaces as well as within cells [1]
• Dissolving keratin fibrils [1]
• Skin emits coral-red fluorescence of scales seen under Wood light (UV světlo)
• Secondary to the production of porphyrin by these diphtheroids [1]
• Coproporphyrin III accumulates in cutaneous tissue [1]
• May be negative if the patient bathed prior to presentation

Epidemiologie

Incidence

• Cca 4% [1]
• All over the world
• More in subtropical and tropical areas [1]
• Higher in black people [1]
• Crural form of erythrasma is more common in men [1]

Rizikové faktory

• Heat and humidity
• Excessive sweating/hyperhidrosis
• Delicate cutaneous barrier
• Obesity
• Diabetes mellitus
• Poor hygiene
• Advanced age
• Immunocompromised states [1]

Asociované problémy s erythrasma

• Other corynebacterial skin infections
• Pitted keratolysis [1]
• Trichomycosis axillaris [1]

Prognóza

• Usually a benign condition [1]
• Chronic superficial infection [1]
• Months to years [1]
• Condition tends to recur if the predisposing factors are not eliminated [4]

Komplikace

• Very rare in immunocompetent hosts
• Abscess formation (3 cases) [1]
• Intravascular catheter–related infections (2 cases) [1]
• Primary bacteremia (3 cases) [1]
• Peritoneal catheter–related infections (2 cases) [1]
• Endocarditis (2 cases) [1]
• Pyelonephritis (2 cases) [1]
• Cellulitis (1 case) [1]
• Endophthalmitis (1 case) [1]
• Arteriovenous fistula infection (1 case) [1]
• Cutaneous granuloma (1 case) [1]
• Meningitis (1 case) [1]
• Widespread and invasive
• In predisposed
• In immunocompromised [1]

Diferenciální diagnostika

• Acanthosis Nigricans
• Candidiasis, Cutaneous
• Contact Dermatitis
• Allergic
• Irritant
• Intertrigo
• Psoriasis, Plaque
• Seborrheic Dermatitis
• Tinea Corporis
• Tinea Cruris
• Tinea Pedis [1]

Terapie

Oblečení

• Savé - aby kůže byla v suchu
• Např. Demycan spray po svlečení se (max. větrání - sušení) do kalhot, bot aj.
• Při praní v pračce přidání nějaké šetrné desinfekce k pracímu prášku
• žehlení
• Uskladnění ve skříni
• Suchost
• Možnost vkládat desinfekční mýdla
• Spraye
• Odpařovače
• Pytlíky s bylinkami etc.

Kůže lokálně

Sušit

• Zabránit nadměrnému přehřívání a pocení

Desinfekce

• Desinfekční mýdla
• Chlorhexidin (fórum pacientů)
• Desinfekční šampóny
• Desinfekční spray
• Hypermangan
• Koupel (? - neověřený nápad)
• Obklady [6]

Antibiotika a antimykotika

Citlivost obecně

• Generally susceptible to:
• Penicillins
• First-generation cephalosporins
• Erythromycin
• Cover all likely pathogens in the context [1]
• Inhibits bacterial growth
• Blocking dissociation of peptidyl t-RNA from ribosomes
• RNA-dependent protein synthesis to arrest [1]
• clindamycin
• Ciprofloxacin
• Tetracycline
• Vancomycin [1]
• Significant susceptibility was statistically found to:
• Amoxicillin-clavulanate
• cefaclor
• Fusidic acid [1]
• Study revealed statistically significant resistance to:
• Erythromycin
• Azithromycin
• Penicillin
• Ampicillin [1]
• Multiresistant strains have been isolated [1]
• Possible concomitant infections [1]

Lokálně

• Erytromycin [1]
• Lepší výslekdy po 48h po terapii clarithromycinem [1]
• Bez rozdílu po 7 dnech terapie [1]
• Fusidic acid [5]
• 1. recommended initial treatment - 2% cream [1]
• Inhibits bacterial protein synthesis
• Causing bacterial death [1]
• 
• Tetracycline
• 2. alternativa [1]
• Inhibits cell growth
• Inhibiting mRNA translation
• Binds to 16S part of 30S ribosomal subunit
• Prevents amino-acyl tRNA from binding to A site of ribosome
• Reversible in nature [1]
• Clarithromycin
• Inhibits bacterial growth
• Blocking dissociation of peptidyl t-RNA from ribosomes
• RNA-dependent protein synthesis to arrest [1]
• Miconazole [5]
• Damages fungal cell wall membrane
• Inhibiting biosynthesis of ergosterol
• Nutrients to leak out
• Fungal cell death [1]
• Lotion is preferred in intertriginous areas
• Cream 2%
• Opatrně aby nenmaceroval [1]
• Benzoic acid 6%, salicylic acid 3% (Whitfield's ointment)
• Treats infection and inflammation associated with erythrasma [1]
• Clindamycin
• Bacteriostatic effect
• Interferes with bacterial protein synthesis similarly to erythromycin and chloramphenicol
• Binding to 50S subunit of bacterial ribosome [1]
• Clotrimazol
• Imazol krémpasta [6]
• Endiaron pasta [6]

Celkově

• Amoxicillin-clavulanate
• 3. volba po selhání 1. a 2. [1]

Photodynamic therapy

• Using red light (broadband, peak at 635 nm)
• Clear erythrasma in 23% of 13 patients
• Improve erythrasma in the remaining patients [1]

Literatura: