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BAB III
DISCUSSION
Erythrasma is a super ficial bacterial infection caused by the porphyrin-
producing diphtheroid Corynebacterium minutissimum and characterized by a
welldemarcated red-brown plaque in the axilla, groin, or toe-web spaces.
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Symptoms vary from a completely asymptomatic form, trough a
genitocrural form with considerable pruritus, to a generalized form with scaly
lamellated plaques on the trunk, inguinal area and web spaces of the feet. When
the pruritic, irritation of lesions may cause secondary changes of excoriations and
lichenification.
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The most frequent sites of involvement are the inguinal folds, axilla, and
submammary area. Rarely it spreads to other areas. The lesions are 10 cm, light-
brown plaques, with discrete borders, polycyclic, and covered with fine scales .
There is mild or no pruritus, and the course is chronic without a tendency to
remission. In interdigital spaces and soles, plaques are erythematous with
moderate scaling or vesicles. Erythrasma comprises 10% of cases of so-called
swimmers eczema. It is usually associated with candidiasis and
dermatophytosis. When nails are involved, they are thickened, have a yellow-
orange pigmentation and are striated.
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The lession can sized in miliar until plakat.
Eritroskuamosa lession, mild squama sometimes can be seen as red as brown.
This variaton obvious relationship with lession area and the petient skin.
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The
most common sites are all intertriginous. In the groin, the bacteria is usually found
where the scrotum, touches the tight or in the narrow contact zone between the
labia mayora and tight. Other locations include the axilla, gluteal cleft,
inframmary folds, umbilicus and toe web spaces. Initially small redish brown
macules are see; they tend to calesce into larger patches with sharp border.
Somtimes tiny punctate lessions are scattered about periphery. The skin surfece is
smooth; occasional fine scale is seen. Often the lession is asymptomatic, in other
instance it is pruritic and may be exoriated or in flamed. Mark sweating,
prolonged sitting and similiar activities may trigger the pruritis. In some instance,
nothing is seen. But the area fluoresces.
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Differential diagnosis for this patient is erythrasma, candidiasis cutis,
seborroic dermatitis, tinea cruris et corporis and psoriasis inversa.
Candidiasis
Cutis
Seboroic
Dermatitis
T. Cruris et
Corporis
Psoriasis Inverse
Red, partially
eroded plaques
on the vulva
surrounded by
a delicate collar
in an infant.
Outside the
main lesions
are a few
pustular
satellite lesions
Seborrheic
dermatitis (SD) is a
very common
chronic dermatosis
characterized by
redness and scaling
and occurring in
regions where the
sebaceous glands
are most active,
such as the face
and scalp, the
presternal area, and
in the body folds.

Tinea cruris
Confluent,
erythematous,
scaling plaques
on the medial
thighs, inguinal
folds, and pubic
area. The
margins are
slightly raised
and sharply
marginated.

Psoriasis inverse
may be localized in
the major skin
folds, such as the
axillae, the genitor-
crural region and
the neck. Scaling is
usually minima or
absent and the
lesions show a
glossy sharply
demarcated
erythe,a, which is
often localized to
areas of skin to skin
contact. Sweating is
impaired in affected
areas.
In this case, the patient complained about itchy and redness rash spot in
axila and inguinal since 1 month ago. The red spot were getting bigger 1 month
ago. In the first of the symptom start with a small of red lesion with the severe
itching until the last month before she goes to polyclinic the lesion begin a red
spot with the bigger plaque and exacerbated when sweating. On examination at
regio axilla and inguinal founded patch erythematous with firm boundaries,
plaque size, the number of multiple over rough scaly lesions found simetris
distribution premises.
The diagnostic of eryhtarsma morphologically, there is an initial apperance
of reddish or brownish macular patches, wich gradually spread and can reach the
size of a palm. These lesions attain distinct margins, smaller satellite lession
occasionally occur in neighbouring areas. The surface of the skin is usually
asymptomatic. Occasionally, itchy sensation may start becuase sweating. Without
treatmenr lesions can persist for months or for years, with exacerbations during
the summer.
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On woods lamp examination we found redcoral fluorescence. Based on
literature The use of a woods lamp shows redcoral fluorescence. May be negative
if patient has bathed recently.
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The diagnosis is strongly suggested by the location
and superficial chharacter of the process, but must be confirmed by
demonstration. - Woods lamp examination of erythrasma reveals a coral-red
fluorescence caused by coproporphyn III.
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The fluorescence may persist after
eradication of the Corynrbacterium as the pigment is within a thick stratum
corneum.
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Others support examination is direct microscopic examination of scales with
Gram stain, or Giemsa or KOH, shows rod-like bacteria and filaments.
Microscopic examination is better if scales are removed with Scotch tape and
stained with methylene blue or Gram or Giemsa stains. Organisms can be
visualized better in phase contrast or immersion microscopy. Culture is difficult.
From foot lesions, Staphylococcus, Pseudomonas, and Proteus can be isolated.
culture of the spesific corynecbaterium in abundance from the lesion corroborates
the diagnosis. Gram potive organism in large numbers.
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This examination for
eliminated candidiasis an and tinea.
Management for this patient we use Ceterizine 10 mg twice a day.
erythromicin 500 mg three times a day for 7 days. For topical management we use
fuson Cream and clindamycin. Beside medication, we have to give education for
the patient, such as, we inform to the patient about the disease and treatment plan.
Patient with erythrasma should be advised about the importance of personal
hygiene, don't scratch of lesion, use antiseptic soap for preventive. Based on
literature prophylaxis therapy, topical therapy and systemic antibiotic therapy. For
prophylaxis therapy, wash with benzoyl propixe (bar or wash). Medicated
powders, topical antiseptic alcohol gels like isopropyl or ethanol. For topical
therapy preferable benzoyl peroxide (2,5%) gel daily after showering for 7 days.
Topical erythromicin or clindamycin solution bid for 7 days. Sodium fusidate
ointment, mupirocin ointment or cream. Topical antifungal agents; clotrimazole,
miconazol or econazole. For systemic antibiotic therapy, erythromycin or
tetracycline 250 mg for 14 days.
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Prognosis for these disease is good enough, if all the lession have treated
with diligent and thorough.
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These disease may remain asymptomatic for years or
may undergo periodic exacerbations. Relapses occasionally occur even after
sucessful antibiotic treatment.
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