Majocchi Granuloma Clinical Presentation

Updated: Apr 19, 2023
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Patients may report nonpruritic solitary or multiple persistent papulopustules or plaques. It may appear as crusty scabbing plaques and nodules on the head. [28] The legs are common sites for Majocchi granuloma in young women who frequently shave. Patients may also report 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. [29, 30]

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. [20] 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. [24] Pregnancy, with its inherent altered immune status, may represent a risk factor. [31]

Recurrent Majocchi granulomas may be linked with chemotherapy-induced neutropenia. [32]

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 [33] or on preexistent tinea, may predispose the patient to Majocchi granuloma.



Uncommonly, scarring and alopecia may result from Majocchi granuloma. Widespread cutaneous disease and/or fungal septicemia are potential complications in patients who are immunocompromised.