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. [15, 16, 17] Topical voriconazole solution combined with a systemic antifungal has also been reported as effective for secondary cutaneous aspergillosis. [18] Voriconazole should be the main agent used to treat invasive aspergillus. [12] For Aspergillus-induced onychomycosis, treatment is with oral itraconazole because topical medications have very limited efficacy eradicating fungus from the nails. However, topical efinaconazole treatment, a strong antifungal, has been shown to successfully eradicate ungual Aspergillus infection. [19]
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. [20]
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. [9]
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.
Consultations
Consult a dermatologist for diagnosis, excision, and wound care.
Consult an infectious diseases specialist for treatment recommendations in the setting of systemic disease.
Prevention
Laminar airflow protection and high-efficiency particulate air filters have been reported as effective ways to prevent nosocomial pulmonary aspergillosis in patients who are immunocompromised. To prevent primary cutaneous aspergillosis, use sterile dressings at catheter sites or other susceptible areas. It is recommended that patients at high risk for invasive aspergillosis avoid gardening and construction sites. Allogenic hematopoietic stem cell transplant recipients should have a sterile environment to reduce the risk of infections. In addition, leukemia and transplantation patients should have regular checkups for invasive mold infections. [12]
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Primary cutaneous aspergillosis at a site of an intravenous catheter in a boy with leukemia.
