Medscape is available in 5 Language Editions – Choose your Edition here.


Majocchi Granuloma Clinical Presentation

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
Updated: Jun 22, 2016


Patients may complain of nonpruritic solitary or multiple persistent papulopustules or plaques. The legs are common sites for Majocchi granuloma in young women who frequently shave. Patients may also complain of onychomycosis or tinea pedis.

Two clinical forms of Majocchi granuloma exist, follicular and subcutaneous nodular.

The follicular type is secondary to trauma or topical corticosteroid use. It commonly occurs in young women who repeatedly shave their legs. Long-standing immunosuppression with steroids certainly predisposes individuals to widespread dermatophytosis, a component of which may be follicular papules consistent with Majocchi granuloma.

The subcutaneous nodular type occurs in immunocompromised hosts such as persons with graft versus host disease, those who undergo bone marrow and organ transplantation, and those receiving long-term immunosuppressive medication for lymphoma, leukemia, and autoimmune diseases.[8] Whether trichophytic abscesses in neutropenic bone marrow transplant recipients are Majocchi granulomas is debatable because these patients lack specific cellular immunity. These granulomas may be widespread.[11] Pregnancy, with its inherent altered immune status, may represent a risk factor.[12]

Recurrent Majocchi granulomas may be linked with chemotherapy-induced neutropenia.[13]

Antibiotic use does not result in Majocchi granuloma because Majocchi granuloma is an atypical course of a fungal disease that may result from a modified local and/or systemic immune response or a damaged skin barrier.

The use of potent topical steroids, especially under occlusion[14] or on preexistent tinea, may predispose the patient to Majocchi granuloma.



Majocchi granuloma or granuloma trichophyticum may develop on any hair-bearing area, but most often, the scalp, face,[15] forearms, hands, and legs are involved. It may sometimes involve the pubic area.[16] A superficial perifollicular form of Majocchi granuloma on the scrotum, caused by T rubrum, has been described.[17]

Majocchi granuloma may begin as solitary or multiple well-circumscribed oval patches or as indistinct scaling ones. Majocchi granuloma evolves into perifollicular papulopustules and nodules with or without background erythema and scaling.

A plaque may demonstrate keloidal features, but these findings are unusual. Nodules are often clustered, but they can be solitary as well. Pressure does not result in pus exudation.

Unlike a kerion, granuloma trichophyticum does not become clinically suppurative until late in its course, unless secondarily impetigo develops.

If the cutaneous features of Majocchi granuloma are associated with the use of topical steroids, they may be affected by the complications of topical steroid therapy, including poikiloderma with atrophy and telangiectasia, papular rosacea, or a hypopigmented patch suggestive of indeterminate leprosy.

Majocchi granuloma may rarely resemble Kaposi sarcoma, as it does in patients with AIDS or lymphocytoma cutis. In such cases, Majocchi granulomas are painful and appear as blue-red papules and nodules on an erythematous base.[18]

Majocchi granuloma may appear as a persistent cutaneous plaque in wrestlers and may be considered a type of tinea corporis gladiatorum.[19]



Majocchi granuloma is a foreign body granuloma most commonly caused by T rubrum.T violaceum was the most common organism identified historically.

Other causes of Majocchi granuloma include T mentagrophytes,[20] Trichophyton tonsurans,[9, 21] and E floccosum.[22] The fungal infections may be due to or linked with a widespread contiguous dermatophytosis, immunosuppression, and/or the use of topical steroids.

Contributor Information and Disclosures

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

Disclosure: Nothing to disclose.


Camila K Janniger, MD Clinical Professor of Dermatology, Clinical Associate Professor of Pediatrics, Chief of Pediatric Dermatology, Rutgers New Jersey Medical School

Camila K Janniger, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Lester F Libow, MD Dermatopathologist, South Texas Dermatopathology Laboratory

Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Texas Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

David P Fivenson, MD Associate Director, St Joseph Mercy Hospital Dermatology Program, Ann Arbor, Michigan

David P Fivenson, MD is a member of the following medical societies: American Academy of Dermatology, Michigan State Medical Society, Society for Investigative Dermatology, Photomedicine Society, Wound Healing Society, Michigan Dermatological Society, Medical Dermatology Society

Disclosure: Nothing to disclose.


The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Olegas Ceburkovas, MD, to the development and writing of this article.

  1. Wilson JW, Plunkett OA, Gregersen A. Nodular granulomatous perifolliculitis of the legs caused by Trichophyton rubrum. AMA Arch Derm Syphilol. 1954 Mar. 63(3):258-77. [Medline].

  2. Coelho WS, Diniz LM, Sousa Filho JB, Castro CM. [Case for diagnosis. Granuloma trichophyticum (Majocchi's granuloma)]. An Bras Dermatol. 2009 Jan-Feb. 84(1):85-6. [Medline].

  3. Meinhof W, Hornstein OP, Scheiffarth F. [Multiple subcutaneous Trichophyton rubrum abscesses. Pathomorphosis of a generalized superficial tinea due to impaired immunological resistance]. Hautarzt. 1976 Jul. 27(7):318-27. [Medline].

  4. Radentz WH, Yanase DJ. Papular lesions in an immunocompromised patient. Trichophyton rubrum granulomas (Majocchi's granuloma). Arch Dermatol. 1993 Sep. 129(9):1189-90, 1192-3. [Medline].

  5. Majocchi D. Sopra una nuova trichofizia (granuloma tricofitico): Studi clinici e micologici. [A new trichophyton granuloma: Clinical and mycological studies]. Bull R Acad Med Roma. 1883.

  6. Nakajima H. [The pathophysiology and defense mechanism against superficial and subcutaneous fungal infection]. Nippon Ishinkin Gakkai Zasshi. 2005. 46(1):5-9. [Medline].

  7. Arenas R, Toussaint S, Isa-Isa R. Kerion and dermatophytic granuloma. Mycological and histopathological findings in 19 children with inflammatory tinea capitis of the scalp. Int J Dermatol. 2006 Mar. 45(3):215-9. [Medline].

  8. Steiner UC, Trüeb RM, Schad K, Kamarashev J, Koch S, French LE, et al. Trichophyton rubrum-induced Majocchi's Granuloma in a heart transplant recipient. A therapeutic challenge. J Dermatol Case Rep. 2012 Sep 28. 6(3):70-2. [Medline]. [Full Text].

  9. Liao YH, Chu SH, Hsiao GH, Chou NK, Wang SS, Chiu HC. Majocchi's granuloma caused by Trichophyton tonsurans in a cardiac transplant recipient. Br J Dermatol. 1999 Jun. 140(6):1194-6. [Medline].

  10. Sequeira M, Burdick AE, Elgart GW, Berman B. New-onset Majocchi's granuloma in two kidney transplant recipients under tacrolimus treatment. J Am Acad Dermatol. 1998 Mar. 38(3):486-8. [Medline].

  11. Tateishi Y, Sato H, Akiyama M, et al. Severe generalized deep dermatophytosis due to Trichophyton rubrum (trichophytic granuloma) in a patient with atopic dermatitis. Arch Dermatol. 2004 May. 140(5):624-5. [Medline].

  12. Wang R, Hu Y, Tang H, Zhang T. Majocchi granuloma in a pregnant woman. Obstet Gynecol. 2014 Aug. 124(2 Pt 2 Suppl 1):423-5. [Medline].

  13. Lourdes LS, Mitchell CL, Glavin FL, Schain DC, Kaye FJ. Recurrent Dermatophytosis (Majocchi granuloma) Associated With Chemotherapy-Induced Neutropenia. J Clin Oncol. 2014 Jan 27. [Medline].

  14. Jacobs PH. Majocchi's granuloma (due to therapy with steroid and occlusion). Cutis. 1986 Jul. 38(1):23. [Medline].

  15. Gill M, Sachdeva B, Gill PS, Arora B, Deep A, Karan J. Majocchi's granuloma of the face in an immunocompetent patient. J Dermatol. 2007 Oct. 34(10):702-4. [Medline].

  16. Rallis E, Katoulis A, Rigopoulos D. Pubic Majocchi's Granuloma Unresponsive to Itraconazole Successfully Treated with Oral Terbinafine. Skin Appendage Disord. 2016 Feb. 1 (3):111-3. [Medline].

  17. Cho HR, Lee MH, Haw CR. Majocchi's granuloma of the scrotum. Mycoses. 2007 Nov. 50(6):520-2. [Medline].

  18. Brod C, Benedix F, Rocken M, Schaller M. Trichophytic Majocchi granuloma mimicking Kaposi sarcoma. J Dtsch Dermatol Ges. 2007 Jul. 5(7):591-3. [Medline].

  19. Kurian A, Haber RM. Tinea corporis gladiatorum presenting as a majocchi granuloma. ISRN Dermatol. 2011. 2011:767589. [Medline]. [Full Text].

  20. Trocoli Drakensjö I, Vassilaki I, Bradley M. Majocchis Granuloma Caused by Trichophyton mentagrophytes in 2 Immunocompetent Patients. Actas Dermosifiliogr. 2016 Mar 4. [Medline].

  21. Chen HH, Chiu HC. Facial Majocchi's granuloma caused by Trichophyton tonsurans in an immunocompetent patient. Acta Derm Venereol. 2003. 83(1):65-6. [Medline].

  22. Sanchez-Castellanos ME, Mayorga-Rodriguez JA, Sandoval-Tress C, Hernandez-Torres M. Tinea incognito due to Trichophyton mentagrophytes. Mycoses. 2007 Jan. 50(1):85-7. [Medline].

  23. Patel GA, Schwartz RA. Tinea capitis: still an unsolved problem?. Mycoses. 2009 Dec 11. [Medline].

  24. Ansar A, Farshchian M, Nazeri H, Ghiasian SA. Clinico-epidemiological and Mycological Aspects of Tinea Incognito in Iran: A 16-Year Study. Nippon Ishinkin Gakkai Zasshi. 2011. 52(1):25-32. [Medline].

  25. Mayser PA. [Majocchi granuloma. Advantages of optical brightener staining in a case report]. Hautarzt. 2014 Aug. 65(8):721-4. [Medline].

  26. Bressan AL, Silva RS, Fonseca JC, Alves Mde F. Majocchi's granuloma. An Bras Dermatol. 2011 Aug. 86(4):797-8. [Medline].

  27. Gupta AK, Prussick R, Sibbald RG, Knowles SR. Terbinafine in the treatment of Majocchi's granuloma. Int J Dermatol. 1995 Jul. 34(7):489. [Medline].

  28. Liu HB, Liu F, Kong QT, Shen YN, Lv GX, Liu WD, et al. Successful Treatment of Refractory Majocchi's Granuloma with Voriconazole and Review of Published Literature. Mycopathologia. 2015 Jun 5. [Medline].

  29. Janniger CK. Majocchi's granuloma. Cutis. 1992 Oct. 50(4):267-8. [Medline].

Pseudomonas folliculitis. Courtesy of Hon Pak, MD.
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.