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Pediatric Sporotrichosis Medication

  • Author: William P Baugh, MD; Chief Editor: Russell W Steele, MD  more...
Updated: Jan 31, 2012

Medication Summary

Approach the treatment of sporotrichosis based upon each patient's clinical presentation and severity of illness. Most patients are treated with some form of antifungal therapy. Many agents are reported to be successful. For simple cutaneous forms, a saturated solution of potassium iodide is often used and is the least expensive form of treatment.

Systemic antifungal medications, such as amphotericin B, itraconazole,[10] terbinafine, or fluconazole, may be used to treat more severe forms of sporotrichosis (eg, lymphonodular, pulmonary, osteoarticular, disseminated). For all clinical types of sporotrichosis, continue the treatment course for at least 1 week after clinical cure.


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.

Potassium iodide (SSKI)


For simple cutaneous lesions, the least expensive medication for treatment is a saturated solution of potassium iodide. This approach is commonly used in developing countries because of its low cost. SSKI can be administered on average for approximately 4-6 wk, but as long as 6 months. However, prolonged use should be undertaken with caution (see interactions below). The mechanism of action is unknown. Ineffective for systemic disease.

Itraconazole (Sporanox)


DOC for cutaneous sporotrichosis. A fungistatic azole with broad spectrum of activity because of its inhibition of enzyme 14-alpha-demethylase, which is needed by the fungus for cell wall synthesis. Particularly effective for lymphocutaneous forms of sporotrichosis but may be used for fixed cutaneous and systemic forms. The caps and PO solution are not interchangeable (PO solution exhibits higher bioavailability).

Amphotericin B (Fungizone)


DOC for disseminated or meningeal forms of systemic sporotrichosis. Some providers even consider this DOC for lymphocutaneous forms of sporotrichosis.

Polyene antibiotic produced by a strain of Streptomyces nodosus; can be fungistatic or fungicidal. Binds to sterols, such as ergosterol, in the fungal cell membrane, causing intracellular components to leak with subsequent fungal cell death.

Terbinafine (Daskil, Lamisil)


A fungicidal allylamine antifungal agent. Considered a third-line agent against sporotrichosis. Blocks ergosterol synthesis by inhibiting squalene epoxidase. Effective against S schenckii and other fungi and fungal infections, including most dermatophytes, Aspergillus species, blastomycosis, histoplasmosis, and Scopulariopsis brevicaulis. Terbinafine is well absorbed PO and has a long half-life.

No elixir form is available; 250-mg tab is not scored and cannot be easily pulverized for use in children and is not palatable.

Fluconazole (Diflucan)


A broad-spectrum azole antifungal agent. Considered a third-line agent for sporotrichosis treatment. Effective for various fungi, including dermatophytes, candidal species, S schenckii, and some molds. It inhibits the enzyme 14-alpha-demethylase, preventing fungal cell wall formation.

Contributor Information and Disclosures

William P Baugh, MD Assistant Clinical Professor of Dermatology, Western University of Health Sciences; Medical Director, Full Spectrum Dermatology; Consulting Staff, Department of Dermatology, St Jude Medical Center

William P Baugh, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Laser Medicine and Surgery, Christian Medical and Dental Associations

Disclosure: Nothing to disclose.


Brad S Graham, MD Consulting Staff, Dermatology Associates of Tyler

Brad S Graham, MD is a member of the following medical societies: Alpha Omega Alpha, Texas Dermatological Society, American Academy of Dermatology, American Society of Dermatopathology

Disclosure: Nothing to disclose.

Cynthia L Chen, DO, DO Intern, Pacific Hospital of Long Beach, California

Cynthia L Chen, DO, DO is a member of the following medical societies: American Osteopathic Association, California Medical Association, American Osteopathic College of Dermatology, Los Angeles County Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Larry I Lutwick, MD Professor of Medicine, State University of New York Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus

Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Gary J Noel, MD Professor, Department of Pediatrics, Weill Cornell Medical College; Attending Pediatrician, New York-Presbyterian Hospital

Gary J Noel, MD is a member of the following medical societies: Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

  1. [Guideline] Kauffman CA, Bustamante B, Chapman SW, Pappas PG. Clinical practice guidelines for the management of sporotrichosis: 2007 update by the Infectious Diseases Society of America. Clin Infect Dis. 2007 Nov 15. 45(10):1255-65. [Medline].

  2. Vilela R, Souza GF, Fernandes Cota G, Mendoza L. Cutaneous and meningeal sporotrichosis in a HIV patient. Rev Iberoam Micol. 2007 Jun. 24(2):161-3. [Medline].

  3. Zhou CH, Asuncion A, Love GL. Laryngeal and respiratory tract sporotrichosis and steroid inhaler use. Arch Pathol Lab Med. 2003 Jul. 127(7):893-4. [Medline].

  4. Lyon GM, Zurita S, Casquero J, et al. Population-based surveillance and a case-control study of risk factors for endemic lymphocutaneous sporotrichosis in Peru. Clin Infect Dis. 2003 Jan 1. 36(1):34-9. [Medline].

  5. Leme LR, Schubach TM, Santos IB, et al. Mycological evaluation of bronchoalveolar lavage in cats with respiratory signs from Rio de Janeiro, Brazil. Mycoses. 2007 May. 50(3):210-4. [Medline].

  6. Feeney KT, Arthur IH, Whittle AJ, Altman SA, Speers DJ. Outbreak of sporotrichosis, Western Australia. Emerg Infect Dis. 2007 Aug. 13(8):1228-31. [Medline].

  7. Song Y, Li SS, Zhong SX, Liu YY, Yao L, Huo SS. Report of 457 sporotrichosis cases from Jilin province, northeast China, a serious endemic region. J Eur Acad Dermatol Venereol. 2011 Dec 17. [Medline].

  8. Almeida-Paes R, Pimenta MA, Pizzini CV, Monteiro PC, Peralta JM, Nosanchuk JD. Use of mycelial-phase Sporothrix schenckii exoantigens in an enzyme-linked immunosorbent assay for diagnosis of sporotrichosis by antibody detection. Clin Vaccine Immunol. 2007 Mar. 14(3):244-9. [Medline].

  9. Sharma NL, Mahajan VK, Verma N, Thakur S. Cutaneous sporotrichosis: an unusual clinico-pathologic and therapeutic presentation. Mycoses. 2003 Dec. 46(11-12):515-8. [Medline].

  10. Bonifaz A, Fierro L, Saul A, Ponce RM. Cutaneous sporotrichosis. Intermittent treatment (pulses) with itraconazole. Eur J Dermatol. 2008 Jan-Feb. 18(1):61-4. [Medline].

  11. Almeida-Paes R, Pimenta MA, Monteiro PC, Nosanchuk JD, Zancope-Oliveira RM. Immunoglobulins G, M, and A against Sporothrix schenckii exoantigens in patients with sporotrichosis before and during treatment with itraconazole. Clin Vaccine Immunol. 2007 Sep. 14(9):1149-57. [Medline].

  12. Baroni A, Palla M, Iovene MR, et al. Sporotrichosis: success of itraconazole treatment. Skinmed. 2007 Jan-Feb. 6(1):41-4. [Medline].

  13. Baum GL, Donnerberg RL, Stewart D. Pulmonary sporotrichosis. N Engl J Med. 1969 Feb 20. 280(8):410-3. [Medline].

  14. Bonifaz A, Peniche A, Mercadillo P. Successful treatment of AIDS-related disseminated cutaneous sporotrichosis with itraconazole. AIDS Patient Care STDS. 2001 Dec. 15(12):603-6. [Medline].

  15. Davis BA. Sporotrichosis. Dermatol Clin. 1996 Jan. 14(1):69-76. [Medline].

  16. De Araujo T, Marques AC, Kerdel F. Sporotrichosis. Int J Dermatol. 2001 Dec. 40(12):737-42. [Medline].

  17. Dolezal JF. Blastomycoid sporotrichosis. Response to low-dose amphotericin B. J Am Acad Dermatol. 1981 May. 4(5):523-7. [Medline].

  18. Dunstan RW, Langham RF, Reimann KA. Feline sporotrichosis: a report of five cases with transmission to humans. J Am Acad Dermatol. 1986 Jul. 15(1):37-45. [Medline].

  19. Gordhan A, Ramdial PK, Morar N. Disseminated cutaneous sporotrichosis: a marker of osteoarticular sporotrichosis masquerading as gout. Int J Dermatol. 2001 Nov. 40(11):717-9. [Medline].

  20. Hajjeh R, McDonnell S, Reef S. Outbreak of sporotrichosis among tree nursery workers. J Infect Dis. 1997 Aug. 176(2):499-504. [Medline].

  21. Horii KA, Jackson MA, Sharma V. Localized cutaneous sporotrichosis in a child. Arch Dermatol. 2006 Oct. 142(10):1369-70. [Medline].

  22. Karakayali G, Lenk N, Alli N. Itraconazole therapy in lymphocutaneous sporotrichosis: a case report and review of the literature. Cutis. 1998 Feb. 61(2):106-7. [Medline].

  23. Kauffman CA, Pappas PG, McKinsey DS. Treatment of lymphocutaneous and visceral sporotrichosis with fluconazole. Clin Infect Dis. 1996 Jan. 22(1):46-50. [Medline].

  24. Lynch PJ, Voorhees JJ, Harrell ER. Systemic sporotrichosis. Ann Intern Med. 1970 Jul. 73(1):23-30. [Medline].

  25. Meffert JJ. Cutaneous sporotrichosis presenting as a keratoacanthoma. Cutis. 1998 Jul. 62(1):37-9. [Medline].

  26. Mohan N, Jayaseelan E, Abraham A. Cutaneous sporotrichosis in Bangalore, southern India. Int J Dermatol. 43(4):269-72. [Medline].

  27. O'Reilly LC, Altman SA. Macrorestriction analysis of clinical and environmental isolates of Sporothrix schenckii. J Clin Microbiol. 2006 Jul. 44(7):2547-52. [Medline].

  28. Rodriguez G, Sarmiento L. The asteroid bodies of sporotrichosis. Am J Dermatopathol. 1998 Jun. 20(3):246-9. [Medline].

  29. Sandhu K, Gupta S. Potassium iodide remains the most effective therapy for cutaneous sporotrichosis. J Dermatolog Treat. 2003 Dec. 14(4):200-2. [Medline].

  30. Sanz J, Andreu JL, Martinez-Garcia G. Sporotrichial bursitis. Br J Rheumatol. 1998 Apr. 37(4):461-2. [Medline].

  31. Sharma NL, Mahajan VK, Verma N, Thakur S. Cutaneous sporotrichosis: an unusual clinico-pathologic and therapeutic presentation. Mycoses. 2003 Dec. 46(11-12):515-8. [Medline].

  32. Ticoras CJ, Schroeter AL, Hornbeck KL. Disseminated ulcerated papules and nodules. Cutaneous disseminated sporotrichosis. Arch Dermatol. 1996 Aug. 132(8):963-4, 966-7. [Medline].

  33. Ware AJ, Cockerell CJ, Skiest DJ. Disseminated sporotrichosis with extensive cutaneous involvement in a patient with AIDS. J Am Acad Dermatol. 1999 Feb. 40(2 Pt 2):350-5. [Medline].

  34. Werner AH, Werner BE. Sporotrichosis in man and animal. Int J Dermatol. 1994 Oct. 33(10):692-700. [Medline].

  35. Whitfeld MJ, Faust HB. Lymphocutaneous sporotrichosis. Australas J Dermatol. 1995 Aug. 36(3):161-3. [Medline].

  36. Zaharopoulos P. Fine-needle aspiration cytologic diagnosis of lymphocutaneous sporotrichosis: a case report. Diagn Cytopathol. 1999 Feb. 20(2):74-7. [Medline].

Sporotrichosis with cutaneous necrosis and lymphangitic (sporotrichoid) spread. A 28-year-old white man presented for evaluation of a poorly healing, asymptomatic, round plaque acquired on the dorsum of his left hand. The lesion had been present for approximately 3 weeks.
Glucose-peptone agar culture plates revealing colony growth of Sporothrix schenckii. The left plate reveals older colonies as dark brown or black, and the right plate reveals younger white colonies with a brown center, characteristic of this fungus.
Microscopic examination of a blue dye preparation from the colony surface reveals elongated septate hyphae with groups of microconidia in a flowerlike arrangement.
A well-circumscribed, moderately elevated, erythematous plaque with central ulceration is found on the dorsum of this patient's left hand. Potassium chloride (KOH) stain was negative for fungal elements.
A 2 X 2 cm, dome-shaped, well-circumscribed, erythematous plaque is shown proximal to the left ring finger. The lesion was draining a serosanguineous fluid. No purulence was noted.
Biopsy rarely reveals the 6-mcg cigar-shaped yeast within tissue macrophages as shown in this histologic section. This is the morphology that Sporothrix schenckii assumes at 37°C.
Moist cream-colored colonies with a central, dark, leathery, and wrinkled surface growing at 25°C is highly suggestive of Sporothrix schenckii.
A fresh agar slant of Sporothrix schenckii reveals moist, white-to-cream–colored, yeastlike colonies.
Cutaneous, ulcerating, painless nodule on the hand and a classic sporotrichoid lymphangitic pattern spreading proximally up the arm.
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