ERYTHRASMA

1151

ERYTHRASMA¹

Definition.—A vegetable parasitic disease characterized by reddish-
brown patches, presenting in situations where there are moist and op­
posing surfaces, as the genitocrural and axillary regions.

The original observations by Burchardt (1859), Barensprung (1862),
and Köbner (1866), which led to the recognition of the individuality of
this affection, have been corroborated by the studies of Besnier, Balzer,
Dubreuilh, Riehl, Weyl, Köbner, Payne, Boeck, Ducrey and Reale, and
others, and have dispelled the belief held by a few German writers as to
its kinship with either tinea trichophytina or tinea versicolor.

Symptoms.—The malady is slow in its development, beginning as
small spots of a reddish-brown or orange-red color, and usually in the
genitocrural region. The color is somewhat like that of the Indian skin.
The spots, which may be few or many in number, gradually increase in
size, and result in coalescence and the formation of confluent areas or
sheets of eruption. In its general aspects, except the shade of coloring
and the parts invaded, it bears considerable resemblance to tinea versi-
color. The patches are not perceptibly elevated, although the edges are
well defined. Scaliness, furfuraceous or mealy in character, is generally
so scanty that its existence is scarcely recognizable; it is more readily
seen at the border. While the most frequent region involved is the
genitocrural, the axillae are also almost as common a site, these two loca­
tions, in fact, being both affected in­most instances. It occasionally ex­
tends from these parts, and may cover considerable surface; in a case
observed by Riehl extending high up on the pubic region and to the
middle of the thighs, and in one by Besnier involving the latter and
also the upper arms. Exceptionally patches may arise independently
near by or not far distant. The malady is insidious and slowly progress­
ive, but generally, after attaining a variable development, remains
practically stationary. There is rarely any tendency to spontaneous
disappearance. Its presence, as a rule, gives rise to no inconvenience,
but occasionally there may be slight itching.

Etiology and Pathology—The disease is rare in our country,
but more common in France and Germany. It is seldom seen in those
under the age of fifteen. It is caused by the parasite, the microsporon
minutissimum, considered a vegetable organism somewhat similar to

¹ Important recent literature: Besnier, Besnier-Doyon’s French translation of
Kaposi’s treatise, second ed., 1891; Balzer, “De l’erythrasma,” Annales, 1883, p. 681;
Balzer and Dubreuilh, “Observations et recherches sur l’erythrasma et sur les parasites
de la peau a l’état normal,” ibid., 1884, pp. 597 and 661 (with review and literature
references); Behrend, Lehrbuch der Hautkrankheiten, 1883, second ed., p. 560, and
Eulenberg’s Real Encyclopœdie, third ed., 1895, vol. vii, p. 360 (with bibliography);
Riehl, Wien. med. Wochenschr., 1884, pp. 1209 and 1247—full abstract in Jour. Cutan.
Dis., 1885, p. 84; Köbner (second paper), Monatshefte, 1884, p. 349; Bizzozero, “Ueber
die Mikrophyten der normale Oberhaut der Menschen,” Virchow’s Archiv, 1884, vol.
xcviii, p. 441 (with review and literature references); Weyl, Monatshefte, 1884, p. 33;
Boeck, Archiv, 1886, p. 119; Payne, London Patholog. Soc’y Trans., 1886, vol. xxxvii, p.
516, and Observations on Some Rare Diseases of the Skin, London, 1889 (a clear
presentation with review); Pasquale de Michele, Giorn. internaz. d. sci. med., 1890—abs.
by Thibiérge in Annales, 1891, p. 796; Ducrey and Reale, abs. in Brit. Jour. Derm.,
1894, p. 126, and abs. of later paper, ibid., 1895, p. 97.

1152

PARASITIC AFFECTIONS

that of tinea versicolor, although there is some doubt as to its exact
status, whether it should be classed among the ordinary tinea fungi or
bacteria. Payne believes the organism bears a strong resemblance to
involution forms of bacilli, being doubtful as to the presence of any
spores, although other observers (Burchardt, Bärensprung, Balzer,
Ducrey, Reale, Weyl, de Michele, Riehl, Dubreuilh, and others) for the
most part are in agreement as to the existence of both mycelium and
spores. Some have found several organisms (Weyl, de Michele), al­
though de Michele’s inoculation experiments show the microsporon to be
the etiologic one. The alleged successful cultures of the organism by de
Michele and Ducrey and Reale are not, however, free from suspicion
(Jarisch). Inasmuch as Balzer and Dubreuilh and Ducrey and Reale
have found the same organism on apparently normal skin, they are in­
clined to believe that only under certain unknown conditions does it
become pathogenic

The microsporon, seated in the superficial horny layers, consists of
short, jointed threads and spores, being in size about one-third that of the
microsporon furfur, and requires, therefore, a somewhat higher power
for its recognition. The threads show no disposition to branching,
exhibit sometimes cylindric swellings, and, according to Payne, some­
times with slightly bulbous blind extremities. Unlike the fungus of tinea
versicolor, as Unna states, it shows no isolated collections of spores.

Diagnosis.—The disease is to be distinguished from tinea versi-
color, to which it bears, as already stated, considerable resemblance,
although it, unlike the former, has a reddish tinge. Tinea versicolor,
however, rarely exists, any length of time at least, on the favorite regions
of erythrasma without marked involvement of its common situation,
the trunk. Erythrasma, on the contrary, is only exceptionally seen
outside of the genitocrural and axillary regions, and then scantily, and,
as a rule, only in association with its extensive development on the parts
named. In doubtful cases recourse can be had to the microscope, al­
though the treatment of both maladies is the same. The inflammatory
characters of tinea cruris (eczema marginatum) and dermatitis sebor-
rhoica, not uncommon in the same localities, will prevent error. The
peculiar patchy and scaly features of pityriasis rosea, as well as its
acute development and distribution, are totally different from those
of erythrasma.

Prognosis and Treatment.—The malady is persistent, and
with, as in tinea versicolor, a marked tendency after apparent cure to
recurrence. The treatment is the same as in the latter disease, and
the same measures as to guarding against relapse should also be advised.

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