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Updated: Dec 16 2021


  • Snapshot
    • A 50-year-old man presents with a rash on his right foot. He reports noticing this rash between his fourth and fifth toe a few days ago, and denies any symptoms related to the rash. He has a past medical history of diabetes managed with metformin, and obesity. He lives in Chicago, where it is currently summer and very humid. On physical exam, there is a erythematous and macerated scaly plaque between his fourth and fifth toe. He is given topical antibiotics for management of this disease.
  • Introduction
    • Clinical definition
      • superficial infection of the skin caused by Corynebacterium minutissimum
        • characterized by maceration and scaly plaques in skin folds
    • Associated conditions
      • trichomycosis axillaris
        • another condition caused by C. tenuis
  • Epidemiology
    • Demographics
      • higher in soldiers and hospitalized patients
      • rare in children
    • Risk factors
      • humid conditions
      • immunocompromised state
      • diabetes
      • obesity
      • hyperhidrosis
  • Etiology
    • Infection by gram-positive bacillus, C. minutissimum
    • Pathogenesis
      • C. minutissimum is a part of normal skin flora
      • if conditions are too moist or occlusive, the bacteria can proliferate in the stratum corneum, disrupting the skin and causing maceration and flaky plaques
  • Presentation
    • Symptoms
      • may be asymptomatic or pruritic
    • Physical exam
      • location
        • toe webs (most common)
          • scaling
          • maceration of toe web spaces
        • intertriginous (groin or axilla most common)
          • erythematous thin plaques
          • initially red but can progress to brown
          • lesions have overlying fine scaling and wrinkling
          • “cigarette paper”-like
  • Studies
    • Wood’s lamp examination
      • coral-red fluorescence
    • Gram stain of skin scraping
      • gram-positive filaments and rods
    • KOH preparation
      • to rule out simultaneous dermatophyte infection
    • Diagnostic criteria
      • typically based on clinical exam and history
      • Wood’s lamp exam can confirm diagnosis
  • Differential
    • Seborrheic dermatitis
      • negative Wood’s lamp examination
      • greasy scaling
    • Tinea versicolor
      • negative Wood’s lamp examination
  • Treatment
    • Medical
      • topical therapy
        • indication
          • localized disease
        • drugs
          • clindamycin/erythromycin
          • fusidic acid
          • imidazole antifungals
            • has activity against some gram-positive bacteria, including C. minutissimum
      • oral therapy
        • indications
          • widespread disease
        • drugs
          • erythromycin
          • clarithromycin
  • Complications
    • Secondary bacterial infection
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