The new england journal of medicine

images in clinical medicine

A Brilliant Case of Erythrasma

A B

Scott D. Miller, M.D.

Waccamaw Dermatology
Myrtle Beach, SC 29572

Kathleen David-Bajar, M.D.

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 prescrip-
tion and over-the-counter antifungal agents, topical corticosteroid preparations of var-
ious strengths, emollients, and home remedies, the patient finally attributed the con-
dition to staining of his skin from dark-colored underclothes. Physical examination
Brooke Army Medical Center
Fort Sam Houston, TX 78234-6000
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 ele-
ments. Illumination of the plaque with a Wood’s lamp, which emits ultraviolet A radi-
ation, revealed a brilliant, coral-red fluorescence, characteristic of the porphyrin pig-
ments produced by Corynebacterium minutissimum in erythrasma (Panel B). The plaque
cleared readily with twice-daily application of a topical gel containing 2 percent eryth-
romycin.
Copyright © 2004 Massachusetts Medical Society.

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1666 n engl j med 351;16 www.nejm.org october 14, 2004

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