Dermatology Information By Dr Ajmal Rashid

29/08/2026

🦠 ERYTHRASMA
● A Superficial Bacterial Infection of the Intertriginous Areas

🔬 Definition
• Erythrasma is a superficial bacterial infection of the stratum corneum caused by Corynebacterium minutissimum.

• It typically affects intertriginous areas, especially the axillae, groin, and inframammary fold

🧬 Etiology & Risk Factors
• The causative organism is Corynebacterium minutissimum, a Gram-positive, non-spore-forming bacillus that normally colonizes the skin.

● Predisposing factors:
• 🌡️ Warm and humid climate
• 💧 Excessive sweating
• ⚖️ Obesity
• 🍬 Diabetes mellitus
• 👴 Older age
• 🧼 Poor hygiene
• 👕 Occlusive clothing
• Immunosuppression

👁️ Clinical Features :

Erythrasma presents as:
• Well-demarcated brownish-red or reddish-brown patches
• Fine scaling may be present
• Usually asymptomatic
• Sometimes associated with mild itching or burning
• Commonly found in:
◦ Axillae
◦ Groin
◦ Inframammary folds
◦ Interdigital spaces

The lesions may gradually enlarge and become confluen

🔦 Wood’s Lamp Examination
⭐ A Key Diagnostic Clue
• Under Wood’s lamp, erythrasma typically shows a characteristic:

🩷 CORAL-RED FLUORESCENCE :
This is caused by porphyrins produced by Corynebacterium minutissimum.
⚠️ Important: The fluorescence may disappear after washing the area because the porphyrins are water-soluble.

🔬 Diagnosis
• Diagnosis is usually clinical, supported by Wood’s lamp examination.

● Differential Diagnosis
Erythrasma should be differentiated from:

• 🔴 Tinea cruris
• 🔴 Candidal intertrigo
• 🔴 Inverse psoriasis
• 🔴 Contact dermatitis
• 🔴 Seborrheic dermatitis

Helpful distinction:

• Erythrasma → coral-red fluorescence
• Tinea → KOH positive
• Candidiasis → satellite pustules + KOH showing pseudohyphae

💊 MANAGEMENT

1️⃣ Topical Treatment
For localized disease:

• Clindamycin 1% topical
• Erythromycin topical
• Fusidic acid topical
• Benzoyl peroxide wash may be useful as an adjunct

Treatment is generally continued for approximately 1–2 weeks, depending on clinical response and the chosen preparation

2️⃣ Systemic Treatment
For extensive, recurrent, or refractory erythrasma, oral antibiotics may be considered.

Clarithromycin or erythromycin can be effective options.

Treatment choice should take into account:

• Drug interactions
• Pregnancy status
• Allergy history
• Local antimicrobial-resistance patterns

🔄 Prevention of Recurrence

Because erythrasma is favored by moisture and occlusion:

• Keep intertriginous areas dry
• Reduce excessive sweating
• Wear loose, breathable clothing
• Treat associated obesity and diabetes
• Avoid prolonged skin-to-skin moisture and friction
• Consider management of coexisting fungal infection if present

🩺 DERMATOLOGIST'S KEY POINT
• Think of ERYTHRASMA when you see:
A well-defined brown-red patch in an intertriginous area + minimal symptoms + CORAL-RED fluorescence under Wood’s lamp.

⭐ Most useful bedside clue:
Wood’s lamp → Coral-red fluorescence

31/03/2025

18/04/2024

Charlie Chaplin once told a joke in front of an audience..!!

Everyone laughed

And he told the same joke a second time.... only a few laughed.

When he told it for the third time....no one laughed.

Then Charlie Chaplin said beautiful words.

If you can't laugh and laugh at the same joke.....

Why do you cry and cry again at the same pain and sorrow?

18/04/2024

FDA Issues Alert on Counterfeit Botox

The FDA has released guidelines for clinicians and tips to identify the distinguishing features of counterfeit products.

17/04/2024

Synonyms:-

1. Compulsive Pulling of hair

2. Habitual Pulling of hair

3. Hair Pulling disorder

• It is a behavioural condition caused by compulsive pulling of hair which

• It affects up to 4% of the general population.

• The effected individuals keeps on pulling his/her hair leading to loss of hair and bald area.

• There is irresistible desire to pull out hair

• The process of pulling of hair leads to an instant release of tension and sense of relief

■ TWO MAJOR FORMS.

№1. PRESCHOOL CHILDREN

• This form is more common in boys

• Hair are most commonly plucked from frontoparietal region

• This results in patch of hair loss having twisted and broken hair of different lengths

• Scalp skin is otherwise normal

• This form usually resolves spontaneously or with minimal treatment

№2. ADOLESCENT AND ADULTS

• In this age group female to male ratio is 7:1

• Evidence of some psychological or behavioural stress is often present

• Therefore Trichotillomania in this age is intractable

• There is an asymmetrical area over scalp from which hair has been plucked.

• The hair have been reduced to small but varying length in effected area. But are not usually completely lost

• Sometimes the entire scalp is effected

• However margins of scalp are spared

• The skin of scalp appears normal

● SITES OF HAIR LOSS

• Mostly scalp is effected

• However in some cases other areas can be effected like eyelashes, eyebrows ,beard or other hairy areas of body

■ DIFFERENTIAL DIAGNOSIS

□ ALOPECIA AREATA

• In alopecia areata the hair loss is complete but in Trichotillomania hair loss is not complete

• Exclamation hair are seen in alopecia areata while in Trichotillomania broken hair of different lengths are seen

□ TINEA CAPITIS

• Texture of hair is abnormal in Tinea while it's normal in Trichotillomania.

• The scalp is scaly in Tinea capitis but its normal in Trichotillomania

■TREATMENT

• The treatment depends upon age of patient.

● PRESCHOOL CHILDREN

• As mentioned above in this age group the problem tends to settle down spontaneously

• A little counselling and awareness to child and parents is all that is required

●ADOLECENCET AND ADULTS

• In this age group treatment is quite challenging

• The consultation of Psychiatrist / Psychologist is often required

• Treatment options are following

☆№1. BEHAVIOUR MODIFICATION THERAPY

• Behaviour modification therapy is mainstay of treatment. This includes:-

¤.Habit reversal training
¤.Cognitive behavioral therapy

☆№2. PHARMACOTHERAPY

Following drugs have been used

• Clomipramine
• SARIs
• Olanzapine or N-acetylcysteine

SUMMARY TRICHOTILLOMANIA

¤ Recurrent pulling of hair , mostly from scalp

¤ Varying length of hair seen within area of alopecia

¤ Behaviour modification therapy is the mainstay of treatment

Dr Ajmal Rashid
Consultant Dermatologist
Karachi

14/04/2024

There will always be someone ahead of you in life.
Amitabh Bachchan (a bollywood actor) says:
At the peak of my career, I was once travelling by plane. The passenger next to me was elderly gentleman dressed in a simple shirt and pants.

He appeared to be middle class, and well educated.

Other passengers perhaps recognising who I was, but this gentleman appeared to be unconcerned of my presence... He was reading his paper, looking out of the window, and when tea was served, he sipped it quietly.

Trying to strike a conversation with him, I smiled. The man courteously smiled back and said, 'Hello'.

We got talking and I brought up the subject of cinema and movies and asked : "Do you watch films?"

The man replied, 'Oh, very few. I did see one many years ago.'

I mentioned that I worked in the movie industry.

The man replied :
"oh, that’s nice. What do you do?"

I replied :
"I am an actor"

The man nodded, 'Oh, that's wonderful!'
And that was it...

When we landed, I held out my hand and said, " It was good to travel with you. By the way, my name is Amitabh Bachchan!'

The man shook my hand and smiled, "Thank you... nice to have met you...I am *J. R. D. Tata!"*

(Mr TATA is a billionaire industrialist that owns TATA Group of Companies).

I learned on that day that no matter how big you think you are, there is always someone bigger than you. Be humble, it costs nothing.

B E H A V I O R is always Greater Than Knowledge,

Because In Life There Are Many Situations Where Knowledge Fails,

But Behavior Can Handle almost E V E R Y T H I N G!

12/04/2024

Low-dose oral minoxidil (5 mg per day) had similar efficacy to topical minoxidil, 5%, for men with androgenetic alopecia and can be an option for patients who prefer oral therapy or are intolerant to topical treatment. https://ja.ma/4d2MGEW

07/04/2024

RIVER INDUS SKARDU PAKISTAN

While relaxing on Sunday after a hectic week of work, let's go a little away from dermatology and enjoy the beautiful scenes of River Indus at Skardu Pakistan, captured by me through my mobile.
A little gift for nature lovers for today's holiday.

Beautiful and serene views of River Indus while it passes through gorgeous valley of Skardu Pakistan surrounded by high mountains.