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


Majocchi Granuloma Medication

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

Medication Summary

The two classes of antifungal medications most commonly used to treat dermatophyte infections are the azoles and the allylamines. Azoles inhibit lanosterol 14-alpha-demethylase, an enzyme that converts lanosterol to ergosterol, an important component of the fungal cell wall. Membrane damage leads to permeability problems and renders the fungus unable to reproduce. Allylamines inhibit squalene epoxidase, an enzyme that converts squalene to ergosterol, leading to the accumulation of toxic levels of squalene in the cell and cell death. Examples of both classes of antifungal antibiotics are available for topical and systemic administration. Another possible therapy for refractory Majocchi granuloma is voriconazole.[28]

To achieve the best results, particularly with follicular or extensive disease, the authors often recommend a combination of topical and systemic therapy.


Antifungal agents

Class Summary

The mechanism of action may involve an alteration of RNA and DNA metabolism or an intracellular accumulation of peroxide that is toxic to the fungal cell.

Terbinafine (Lamisil)


Terbinafine is an allylamine derivative that inhibits squalene epoxidase, a key enzyme in sterol biosynthesis in fungi. This inhibition results in a deficiency in ergosterol within the fungal cell wall that causes fungal cell death. Terbinafine is available by prescription only. Some clinicians reserve the use of this drug for more widespread and/or resistant infections because of its broad coverage and cost. This medication is effective and well tolerated in children.

Butenafine (Mentax)


Butenafine is a potent antifungal related to the allylamines. It damages fungal cell membranes, arresting fungal cell growth. Butenafine is available in cream form only. Use 1% cream.

Clotrimazole (Lotrimin, Mycelex)


Clotrimazole is a broad-spectrum agent that inhibits fungal growth by altering cell membrane permeability, causing fungal cell death. Reevaluate the diagnosis if no clinical improvement is seen after 4 weeks. Often, clotrimazole is a first-line topical drug. It is available by prescription only. Cream, solution/spray, and lotion forms are available. Use 1%.

Itraconazole (Sporanox)


Itraconazole has fungistatic activity. It is a synthetic triazole antifungal agent that slows fungal cell growth by inhibiting cytochrome P-450–dependent synthesis of ergosterol, a vital component of fungal cell membranes.

Absorption is improved with food and in the presence of normal gastric acidity. Patients should be cautioned against ingesting grapefruit juice while on itraconazole therapy (decreased oral bioavailability of itraconazole). Discontinue if sensitivity or chemical irritation occurs; it is for external use only, and avoid contact with eyes.

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.