Dermatophytosis, Chromomycosis and Majocchi's Granuloma: A Review

8/9/2019 Dermatophytosis, Chromomycosis and Majocchi's Granuloma: A Review.

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Fungus Among Us:Fungus Among Us:A Pathologic Review of Dermatophytosis, MajocchisA Pathologic Review of Dermatophytosis, Majocchis

Granuloma, and ChromomycosisGranuloma, and Chromomycosis

Deba P Sarma, MDDeba P Sarma, MD

OmahaOmaha


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Case #1Case #1

HPI:HPI:

8y/o girl c/o rash on left arm8y/o girl c/o rash on left arm

c/o itching, scaly lesion that is growing in ac/o itching, scaly lesion that is growing in a

circular patterncircular pattern

First noticed lesion 2 weeks agoFirst noticed lesion 2 weeks ago

SH:SH: Lives with parents, 10y/o brother, and familyLives with parents, 10y/o brother, and family

catcat


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Case #1 ContinuedCase #1 Continued

PE:PE:

Afebrile, VSSAfebrile, VSS

Skin:Skin:

Circular 2x2cm lesion on ventral surface ofCircular 2x2cm lesion on ventral surface of

proximal left armproximal left arm

Erythematous with central clearingErythematous with central clearing ScalyScaly

Broken hairs notedBroken hairs noted


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Dermatophytosis:Dermatophytosis:

Very common fungal infectionVery common fungal infection

Classified on basis of locationClassified on basis of location

Tinea capitis, headTinea capitis, head

Keroin, foliclesKeroin, folicles

Favus, chronic infection of scalpFavus, chronic infection of scalp

Tinea faciei, facialTinea faciei, facial

Tinea barbae, beard areaTinea barbae, beard area

Tinea corporis, bodyTinea corporis, body Tinea cruris, groinTinea cruris, groin

Tinea pedis, feetTinea pedis, feet

Onychomycosis, nailOnychomycosis, nail

Caused by dermatophytic fungiCaused by dermatophytic fungi

Epidermophyton, Microsporum,Epidermophyton, Microsporum, andand TrichophytonTrichophyton


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HistologyHistology

Focal parakeratosis and neutrophilic keratitis


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HistologyHistology


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HistologyHistology

PAS stain shows fungal hyphae in the keratin layer


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TreatmentTreatment HairHair--bearing skinbearing skin

Need oral agentNeed oral agent

ItraconazoleItraconazole

FluconazoleFluconazole

Griseofluvin (tinea capitis)Griseofluvin (tinea capitis)

Adjuvent TreatmentAdjuvent Treatment

ShampoosShampoos

Contain selenium sulfide, zinc pyrithione, povidone iodine, orContain selenium sulfide, zinc pyrithione, povidone iodine, or

ketoconazoleketoconazole

Disinfect enviornmentDisinfect enviornment

NonNon--hair bearing skinhair bearing skin

Topical agentsTopical agents

AllylaminesAllylamines

ImidazolesImidazoles


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PEPE


SkinSkin

Multiple erythematous perifolicularMultiple erythematous perifolicular

papulopustulespapulopustules

Some scaling presentSome scaling present

Other SystemsOther Systems

unremarkableunremarkable


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Case #2Case #2

HPIHPI

27y/o female c/o rash on distal right lower27y/o female c/o rash on distal right lower

extremityextremity

c/o multiple red scaly patches on the legc/o multiple red scaly patches on the leg

Reports itching without pain or burningReports itching without pain or burning

sensationsensation Treated with OTC topical steroids, whichTreated with OTC topical steroids, which

only aggravated the areaonly aggravated the area


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Majocchis GranulomaMajocchis Granuloma

Fungal infection of the skinFungal infection of the skin

Incidence linked with contiguousIncidence linked with contiguous

dermatophytosis, immunosuppression, & usedermatophytosis, immunosuppression, & use

of topical steroidsof topical steroids

Trichophyton rubrumTrichophyton rubrum

Most commonly implicated dermatophyteMost commonly implicated dermatophyte

Common on the legs of young womenCommon on the legs of young women

who frequently shavewho frequently shave


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HistologyHistology

Deep dermal folliculitis


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HistologyHistology

Acute suppurative and chronic folliculitisand perifolliculitis


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HistologyHistology

Fungi in the hair


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PAS stain

Fungi within the hair


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TreatmentTreatment

Oral Antifungal for all patientsOral Antifungal for all patients

azolesazoles

Itraconazole (Sporanox)Itraconazole (Sporanox)

AllylaminesAllylamines

Terbinafine (Lamasil)Terbinafine (Lamasil)

Treatment should continue for 4Treatment should continue for 4--6 weeks6 weeks


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Case #3Case #3

HPI:HPI:

42y/o white male c/o rash on right leg that has42y/o white male c/o rash on right leg that has

been increasing in size for the last severalbeen increasing in size for the last several

years.years.

Denies pain, itching, burning, or irritationDenies pain, itching, burning, or irritation

Recently began producing a yellowRecently began producing a yellow--clearclearmalodorous dischargemalodorous discharge


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PE:PE:


Skin:Skin:

3x2cm plaque3x2cm plaque--like scaly lesion with numerous blacklike scaly lesion with numerous black

dots on the surfacedots on the surface of plaque located on ventral surfaceof plaque located on ventral surface

of distal right legof distal right leg

producing malodours mucopurulent discharge.producing malodours mucopurulent discharge.

Other Systems:Other Systems:

unremarkableunremarkable


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ChromomycosisChromomycosis

Chronic fungal infection of skinChronic fungal infection of skin

Traumatic inoculation:Traumatic inoculation:

Not often rememberedNot often remembered

Higher incidence in rural and tropical populationsHigher incidence in rural and tropical populations

Multiple fungi implicatedMultiple fungi implicated

Fonsecaea pedrosi, Phialophora verrucosa, CladosporiumFonsecaea pedrosi, Phialophora verrucosa, Cladosporium

carrionii, Fonsecae compactacarrionii, Fonsecae compacta

Differential DiagnosisDifferential Diagnosis LeishmaniasisLeishmaniasis

SporotrichosisSporotrichosis

Squamous Cell CarcinomaSquamous Cell Carcinoma


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HistologyHistology

Pseudoepitheliomatous hyperplasia of epidermis.

Dermal suppurative and granulomatoous inflammation.


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HistologyHistology

Granulomatous dermatitis with multinucleard giant cells


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HistologyHistology

Medlar Bodies: Thick walled cigar-colored, sclerotic cells(Pigmented fungi) in giant cells


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TreatmentTreatment

MedicalMedical

ItraconazoleItraconazole

Itraconazole + 5Itraconazole + 5--FCFC

Localized heatLocalized heat

SurgicalSurgical

CryosurgeryCryosurgery


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ReferencesReferences

Crosby, R. Mycology Online: Chromoblastomycosis. The University of Adelaide.Crosby, R. Mycology Online: Chromoblastomycosis. The University of Adelaide.

www.mycology.adelaide.edu.au/.../chromo1.htmlwww.mycology.adelaide.edu.au/.../chromo1.html. 2009. 2009

Foong, Henry. Virtual Grand Rounds in Dermatology 2.0. http://vgrd.blogspot.com/2008/05/21Foong, Henry. Virtual Grand Rounds in Dermatology 2.0. http://vgrd.blogspot.com/2008/05/21--

yoyo--manman--withwith--wartywarty--plaqueplaque--onon--foot.html. 2008foot.html. 2008

Frauenfelder, M. Boingboing: A Directory of Wonderful Things.Frauenfelder, M. Boingboing: A Directory of Wonderful Things.www.boingboing.net/.../updatewww.boingboing.net/.../update--marksmarks--tropica.htmltropica.html. 2003. 2003

McGrawMcGraw--Hills Access Medicine.Hills Access Medicine. Treatment of Dermatophytes Dermatology Part 9. ChapterTreatment of Dermatophytes Dermatology Part 9. Chapter

188.188. www.accessmedicine.com/popup.aspx?aID=2996745www.accessmedicine.com/popup.aspx?aID=2996745. 2009. 2009

Rashid, R., MD.Rashid, R., MD. eMedicineeMedicine. Tinea.. Tinea.

http://www.imedicine.com/DisplayTopic.asp?bookid=3&topic=592http://www.imedicine.com/DisplayTopic.asp?bookid=3&topic=592. 2008. 2008

Schwartz, Robert, MD, MPH& Eugeniusz Baran, MD, PhD. eMedicine: Chromoblastomycosis.Schwartz, Robert, MD, MPH& Eugeniusz Baran, MD, PhD. eMedicine: Chromoblastomycosis.

http://emedicine.medscape.com/article/1092695http://emedicine.medscape.com/article/1092695. Feb. 11, 2008. Feb. 11, 2008

Schwartz, Robert, MD, MPH, Olegas Ceburkovas, MD, & Camila K Janniger, MD. eMedicine:Schwartz, Robert, MD, MPH, Olegas Ceburkovas, MD, & Camila K Janniger, MD. eMedicine:

Majocchi Granuloma.Majocchi Granuloma. http://www.imedicine.com/DisplayTopic.asp?bookid=2&topic=849http://www.imedicine.com/DisplayTopic.asp?bookid=2&topic=849. May. May

12, 2008.12, 2008.

Toxic Mold, Black Mold, Household Mold Problems, & Toxic Black Mold Damage InformationToxic Mold, Black Mold, Household Mold Problems, & Toxic Black Mold Damage Information

Center for mold growth in USA, Canada, Central & So. America, Asia, Australia/NZ, Africa &Center for mold growth in USA, Canada, Central & So. America, Asia, Australia/NZ, Africa &

Europe.Europe. http://www.mold.ph/fonsecaea.htmhttp://www.mold.ph/fonsecaea.html. 2008l. 2008--20092009

http://www.unshelved.com/store.aspx?cat=bookshttp://www.unshelved.com/store.aspx?cat=books

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Dermatophytosis, Chromomycosis and Majocchi's Granuloma: A Review