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Dermatologic Manifestations of Aspergillosis Treatment & Management

  • Author: Annie Chiu, MD; Chief Editor: William D James, MD  more...
 
Updated: Mar 13, 2014
 

Medical Care

In both disseminated and limited cutaneous aspergillosis, high-dose intravenous amphotericin B, in traditional or liposomal form has been the traditional antifungal used to eradicate the underlying organism. However, voriconazole is also approved as a first-line agent for aspergillosis and is being used with increased frequency. Other treatment options for aspergillosis include itraconazole, caspofungin, or voriconazole in combination with terbinafine.[9, 10, 11] Topical voriconazole solution combined with a systemic antifungal has also been reported as effective for secondary cutaneous aspergillosis.[12] For Aspergillus -induced onychomycosis, treatment is with oral itraconazole because topical medications have very limited efficacy in eradicating fungus from the nail.

From a more homeopathic standpoint, a recent study showed in vitro antifungal activity of essential oil of Juniperus communis against A flavus, A fumigatus, and A niger.[13]

In the case of secondary wound infection of the scalp with A niger, treatment with ketoconazole 2% gel and retapamulin ointment resulted in resolution of the nonhealing wound.[5]

Also see the clinical guideline summary, Treatment of Aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America.[14]

The following is a selection of active, recruiting, or completed clinical trials:

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Surgical Care

Several case reports have documented the effectiveness of surgical excision or debridement in the treatment of primary cutaneous aspergillosis. Some of the patients also received concurrent or subsequent systemic antifungal therapy.

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Consultations

See the list below:

  • Consult a dermatologist for diagnosis, excision, and wound care.
  • Consult an infectious diseases specialist for treatment recommendations in the setting of systemic disease.
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Contributor Information and Disclosures
Author

Annie Chiu, MD Cosmetic and General Dermatologist

Annie Chiu, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery, Women's Dermatologic Society

Disclosure: Received consulting fee from Temptu for consulting; Received honoraria from Galderma for consulting; Received honoraria from SkinMedica for consulting.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Jeffrey Meffert, MD Associate Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio

Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Acknowledgements

Alexa F Boer Kimball, MD, MPH Associate Professor of Dermatology, Harvard University School of Medicine; Vice Chair, Department of Dermatology, Massachusetts General Hospital; Director of Clinical Unit for Research Trials in Skin (CURTIS), Department of Dermatology, Massachusetts General Hospital

Alexa F Boer Kimball, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Peter Fritsch, MD Chair, Department of Dermatology and Venereology, University of Innsbruck, Austria

Peter Fritsch, MD is a member of the following medical societies: American Dermatological Association, International Society of Pediatric Dermatology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

References
  1. Ozer B, Kalaci A, Duran N, Dogramaci Y, Yanat AN. Cutaneous infection caused by Aspergillus terreus. J Med Microbiol. 2009 Jul. 58:968-70. [Medline].

  2. Zhang QQ, Li L, Zhu M, Zhang CY, Wang JJ. Primary cutaneous aspergillosis due to Aspergillus flavus: a case report. Chin Med J (Engl). 2005 Feb 5. 118(3):255-7. [Medline].

  3. Mohapatra S, Xess I, Swetha JV, et al. Primary cutaneous aspergillosis due to Aspergillus niger in an immunocompetent patient. Indian J Med Microbiol. 2009 Oct-Dec. 27(4):367-70. [Medline].

  4. Larkin JA, Greene JN, Sandin RL, Houston SH. Primary cutaneous aspergillosis: case report and review of the literature. Infect Control Hosp Epidemiol. 1996 Jun. 17(6):365-6. [Medline].

  5. Robinson A, Fien S, Grassi MA. Nonhealing scalp wound infected with Aspergillus niger in an elderly patient. Cutis. 2011 Apr. 87(4):197-200. [Medline].

  6. Naidu J, Singh SM. Aspergillus chevalieri (Mangin) Thom and Church: a new opportunistic pathogen of human cutaneous aspergillosis. Mycoses. 1994 Jul-Aug. 37(7-8):271-4. [Medline].

  7. Kim CW, Seo JS, Kim MK, Jun EJ, Choi JC, Choi BW. Secondary cutaneous aspergillosis disseminated from the lungs of a patient with asthma on 1 month steroid treatment. Diagn Microbiol Infect Dis. 2010 Jan. 66(1):104-7. [Medline].

  8. Wheat LJ. Rapid diagnosis of invasive aspergillosis by antigen detection. Transpl Infect Dis. 2003 Dec. 5(4):158-66. [Medline].

  9. Krishnan-Natesan S, Chandrasekar PH, Manavathu EK, Revankar SG. Successful treatment of primary cutaneous Aspergillus ustus infection with surgical debridement and a combination of voriconazole and terbinafine. Diagn Microbiol Infect Dis. 2008 Dec. 62(4):443-6. [Medline].

  10. Cooke FJ, Terpos E, Boyle J, Rahemtulla A, Rogers TR. Disseminated Aspergillus terreus infection arising from cutaneous inoculation treated with caspofungin. Clin Microbiol Infect. 2003 Dec. 9(12):1238-41. [Medline].

  11. Koss T, Bagheri B, Zeana C, Romagnoli MF, Grossman ME. Amphotericin B-resistant Aspergillus flavus infection successfully treated with caspofungin, a novel antifungal agent. J Am Acad Dermatol. 2002 Jun. 46(6):945-7. [Medline].

  12. Klein KC, Blackwood RA. Topical voriconazole solution for cutaneous aspergillosis in a pediatric patient after bone marrow transplant. Pediatrics. 2006 Aug. 118(2):e506-8. [Medline].

  13. Cabral C, Francisco V, Cavaleiro C, et al. Essential Oil of Juniperus communis subsp. alpina (Suter) Celak Needles: Chemical Composition, Antifungal Activity and Cytotoxicity. Phytother Res. 2012 Feb 1. [Medline].

  14. [Guideline] Walsh TJ, Anaissie EJ, Denning DW, et al. Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis. 2008 Feb 1. 46(3):327-60. [Medline].

  15. Herbrecht R, Denning DW, Patterson TF, Bennett JE, Greene RE, Oestmann JW, et al. Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med. 2002 Aug 8. 347(6):408-15. [Medline].

  16. Walsh TJ, Raad I, Patterson TF, et al. Treatment of invasive aspergillosis with posaconazole in patients who are refractory to or intolerant of conventional therapy: an externally controlled trial. Clin Infect Dis. 2007 Jan 1. 44(1):2-12. [Medline].

  17. Elder D, Elenitsas R, Jaworsky C, eds. Lever's Histopathology of the Skin. Philadelphia, Pa: Lippincott-Raven; 1997. 525-6.

  18. Freedberg I, Eisen AZ, Wolff K, et al, eds. Fitzpatrick's Dermatology in General Medicine. 5th ed. New York, NY: McGraw-Hill; 1999. 1436-7.

  19. Odom RB, James WD, Berger TG, eds. Andrews' Diseases of the Skin. Philadelphia, Pa: WB Saunders; 2000. 415.

  20. Richardson MD, Warnock DW, eds. Fungal Infection. Diagnosis and Management. 2nd ed. Blackwell Science: Oxford, England; 1997. 113-30.

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Primary cutaneous aspergillosis at a site of an intravenous catheter in a boy with leukemia.
 
 
 
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