Erythrasma: a systematic review of interventions

Erythrasma is a chronic superficial bacterial infection caused by Corynebacterium minutissimum, predominantly affecting intertriginous areas. Cutaneous features include erythema, scaling and skin discoloration; notably, erythema may not manifest as classic redness in individuals with darker skin tones, instead appearing as subtle darkening, violaceous, or other colour changes. Diagnosis in all skin types is supported by the characteristic coral-red fluorescence observed under a Wood's lamp. Despite numerous available treatments, guidance on the most effective therapy is limited. A comprehensive review of studies published between 1971 and 2024, including randomized controlled trials and comparative clinical studies, revealed that both clotrimazole and fusidic acid are effective topical options, with fusidic acid providing faster symptom relief, greater reduction in Wood's lamp fluorescence and fewer side-effects. Clarithromycin was found to be more effective than erythromycin systemically, although gastrointestinal side effects can occur but are not widely reported in all patients. Topical therapies generally showed a better safety profile. Overall, treatment modalities for erythrasma are well tolerated, but there remains a shortage of large-scale randomized trials utilizing standardized outcomes, limiting the establishment of a clear consensus on optimal management.