Majocchi's granuloma: a symptom complex caused by fungal pathogens

Abstract

Majocchi's granuloma (MG) is a well-recognized but uncommon infection of dermal and subcutaneous tissues that is caused by mold fungi. Although primarily caused by keratinophilic dermatophytes such as anthropophilic Trichophyton rubrum, species from the Aspergillus and Phoma genera have been occasionally detected as etiologic agents of MG. In both healthy individuals and immunocompromised hosts, MG often presents as nodules, plaques, and papules on areas that are prone to trauma. Although MG generally appears on the upper and lower extremities (forearms, hands, legs, or ankles), it occasionally appears on the scalp and face. The clinical, mycologic, and/or cytologic diagnosis should be confirmed by the demonstration of perifollicular granulomatous inflammation by histologic examination. This review focuses on the clinical presentation, pathogenesis, laboratory diagnostic methods (including the Tzanck smear test), etiologic agents, histopathologic characteristics, and therapeutic approaches to the treatment of MG.

Fungal Infections From Human and Animal Contact

“…15,16 Topical steroids or occlusion may promote this entity. 6,15 As the differential diagnosis is quite broad, skin biopsy is usually necessary for confirmation. 15 Id Reaction: The id reaction is an acute, local or more generalized, papulovesicular eruption that is usually remote from the site of dermatophyte infection (Figure 12).…”

“…6 This entity is usually precipitated by trauma or shaving, largely on Review the extremities, occasionally on the scalp or face. 6,15,16 It is most common in children and usually presents as localized area of erythema, perifollicular papules, small nodules or pustules (with deeper plaques or larger nodules in the immunocompromised). 15,16 Topical steroids or occlusion may promote this entity.…”

“…6,15,16 It is most common in children and usually presents as localized area of erythema, perifollicular papules, small nodules or pustules (with deeper plaques or larger nodules in the immunocompromised). 15,16 Topical steroids or occlusion may promote this entity. 6,15 As the differential diagnosis is quite broad, skin biopsy is usually necessary for confirmation.…”

“…6,15 As the differential diagnosis is quite broad, skin biopsy is usually necessary for confirmation. 15 Id Reaction: The id reaction is an acute, local or more generalized, papulovesicular eruption that is usually remote from the site of dermatophyte infection (Figure 12). 6,35 It occurs not from direct infection by dermatophytes or other fungal, bacterial, viral or parasitic infection, but rather from sensitization to circulating antigens, in this case, fungal.…”

“…6,35 Treatment Common treatment regimens are summarized in Table 2. 6,8,15,16,27,[35][36][37][38][39][40][41] Localized superficial skin dermatophyte infections may be treated by topical antifungals. 6,8,36 Adding topical corticosteroids to topical antifungal treatment is not suggested by guidelines and does not alter the rate of mycological cure, but may improve time to clinical cure due to treatment of inflammation.…”