Holdiness Mack R
Department of Internal Medicine, Lakeside Hospital, Metairie, Louisiana 70001, USA.
Drugs. 2002;62(8):1131-41. doi: 10.2165/00003495-200262080-00002.
Corynebacterium minutissimum is the bacteria that leads to cutaneous eruptions of erythrasma and is the most common cause of interdigital foot infections. It is found mostly in occluded intertriginous areas such as the axillae, inframammary areas, interspaces of the toes, intergluteal and crural folds, and is more common in individuals with diabetes mellitus than other clinical patients. This organism can be isolated from a cutaneous site along with a concurrent dermatophyte or Candida albicans infection. The differential diagnosis of erythrasma includes psoriasis, dermatophytosis, candidiasis and intertrigo, and methods for differentiating include Wood's light examination and bacterial and mycological cultures. Erythromycin 250mg four times daily for 14 days is the treatment of choice and other antibacterials include tetracycline and chloramphenicol; however, the use of chloramphenicol is limited by bone marrow suppression potentially leading to neutropenia, agranulocytosis and aplastic anaemia. Further studies are needed but clarithromycin may be an additional drug for use in the future. Where there is therapeutic failure or intertriginous involvement, topical solutions such as clindamycin, Whitfield's ointment, sodium fusidate ointment and antibacterial soaps may be required for both treatment and prophylaxis. Limited studies on the efficacy of these medications exist, however, systemic erythromycin demonstrates cure rates as high as 100%. Compared with tetracyclines, systemic erythromycin has greater efficacy in patients with involvement of the axillae and groin, and similar efficacy for interdigital infections. Whitfield's ointment has equal efficacy to systemic erythromycin in the axillae and groin, but shows greater efficacy in the interdigital areas and is comparable with 2% sodium fusidate ointment for treatment of all areas. Adverse drug effects and potential drug interactions need to be considered. No cost-effectiveness data are available but there are limited data on cost-related treatment issues. A guideline is proposed for the detection, evaluation, treatment and prophylaxis of this cutaneous eruption.
纤细棒状杆菌是导致红癣皮肤疹的细菌，也是足趾间感染最常见的病因。它主要存在于闭塞性擦烂部位，如腋窝、乳房下区域、趾间、臀间和股皱襞，在糖尿病患者中比其他临床患者更常见。这种微生物可与同时存在的皮肤癣菌或白色念珠菌感染一起从皮肤部位分离出来。红癣的鉴别诊断包括银屑病、皮肤癣菌病、念珠菌病和擦烂，鉴别方法包括伍德灯检查以及细菌和真菌培养。首选治疗方法是每日4次，每次250mg红霉素，持续14天，其他抗菌药物包括四环素和氯霉素；然而，氯霉素的使用受到骨髓抑制的限制，可能导致中性粒细胞减少、粒细胞缺乏症和再生障碍性贫血。需要进一步研究，但克拉霉素可能是未来可用的另一种药物。在治疗失败或有擦烂累及的情况下，可能需要局部用药，如克林霉素、惠特菲尔德软膏、夫西地酸钠软膏和抗菌肥皂进行治疗和预防。然而，关于这些药物疗效的研究有限，全身应用红霉素的治愈率高达100%。与四环素相比，全身应用红霉素对腋窝和腹股沟受累患者的疗效更高，对趾间感染的疗效相似。惠特菲尔德软膏在腋窝和腹股沟的疗效与全身应用红霉素相当，但在趾间区域显示出更高的疗效，在所有区域的治疗效果与2%夫西地酸钠软膏相当。需要考虑药物不良反应和潜在的药物相互作用。目前尚无成本效益数据，但关于成本相关治疗问题的数据有限。本文提出了一份关于这种皮肤疹的检测、评估、治疗和预防的指南。
