Majocchi Granuloma Medication

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD   more...
 
Updated: May 27, 2011
 

Medication Summary

The 2 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.

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

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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.

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Terbinafine (Lamisil)

 

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.

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Butenafine (Mentax)

 

Potent antifungal related to the allylamines. Damages fungal cell membranes, arresting fungal cell growth. Available in cream form only. Use 1% cream.

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Clotrimazole (Lotrimin, Mycelex)

 

Broad-spectrum agent that inhibits fungal growth by altering cell membrane permeability, causing fungal cell death. Reevaluate diagnosis if no clinical improvement seen after 4 wk. Often a first-line topical drug. Prescription only. Cream, solution/spray, and lotion forms available. Use 1%.

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Itraconazole (Sporanox)

 

Fungistatic activity. 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 improved with food and in 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; for external use only; avoid contact with eyes.

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Contributor Information and Disclosures
Author

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

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

Disclosure: Nothing to disclose.

Coauthor(s)

Camila K Janniger, MD  Clinical Professor of Dermatology, Clinical Associate Professor of Pediatrics, Chief of Pediatric Dermatology, University of Medicine and Dentistry of New Jersey-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

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, Medical Dermatology Society, Michigan Dermatological Society, Michigan State Medical Society, Photomedicine Society, Society for Investigative Dermatology, and Wound Healing Society

Disclosure: Nothing to disclose.

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

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

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

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

Disclosure: Nothing to disclose.

References

  1. Wilson JW, Plunkett OA, Gregersen A. Nodular granulomatous perifolliculitis of the legs caused by Trichophyton rubrum. AMA Arch Derm Syphilol. Mar 1954;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. Jan-Feb 2009;84(1):85-6. [Medline].

  3. 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.

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

  5. 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. Mar 2006;45(3):215-9. [Medline].

  6. 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. May 2004;140(5):624-5. [Medline].

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

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

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

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

  11. 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].

  12. Akiba H, Motoki Y, Satoh M, Iwatsuki K, Kaneko F. Recalcitrant trichophytic granuloma associated with NK-cell deficiency in a SLE patient treated with corticosteroid. Eur J Dermatol. Jan-Feb 2001;11(1):58-62. [Medline].

  13. Alteras I, Feuerman EJ, David M, Shvili D. Unusual aspects of granulomatous dermatophytosis. Mycopathologia. May 30 1984;86(2):93-7. [Medline].

  14. Carter RL. Majocchi's granuloma. J Am Acad Dermatol. Jan 1980;2(1):75. [Medline].

  15. 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].

  16. Elgart ML. Tinea incognito: an update on Majocchi granuloma. Dermatol Clin. Jan 1996;14(1):51-55. [Medline].

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

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

  19. Gupta S, Kumar B, Radotra BD, Rai R. Majocchi's granuloma trichophyticum in an immunocompromised patient. Int J Dermatol. Feb 2000;39(2):140-1. [Medline].

  20. Hirschmann JV, Raugi GJ. Pustular tinea pedis. J Am Acad Dermatol. Jan 2000;42(1 Pt 1):132-3. [Medline].

  21. Ive FA, Marks R. Tinea incognito. Br Med J. Jul 20 1968;3(5611):149-52. [Medline].

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

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

  24. Lepage JC. Source of Majocchi's granuloma. J Am Acad Dermatol. Feb 1983;8(2):260. [Medline].

  25. 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. Jun 1999;140(6):1194-6. [Medline].

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

  27. Nolting C, Vennewald I, Seebacher C. [Tinea follicularis presenting as trichophytic Majocchi granuloma]. Mycoses. 1997;40 Suppl 1:73-5. [Medline].

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

  29. Reynolds RD, Boiko S, Lucky AW. Exacerbation of tinea corporis during treatment with 1% clotrimazole/0.05% betamethasone diproprionate (Lotrisone). Am J Dis Child. Nov 1991;145(11):1224-5. [Medline].

  30. 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. Mar 1998;38(3):486-8. [Medline].

  31. Smith KJ, Neafie RC, Skelton HG 3rd, Barrett TL, Graham JH, Lupton GP. Majocchi's granuloma. J Cutan Pathol. Feb 1991;18(1):28-35. [Medline].

 
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