Majocchi Granuloma Clinical Presentation

Updated: May 14, 2019
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Presentation

History

Patients may complain of nonpruritic solitary or multiple persistent papulopustules or plaques. The legs are common sites for Majocchi granuloma in young women who frequently shave. Patients may also complain of 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. [16, 17]

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. [9] 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. [12] Pregnancy, with its inherent altered immune status, may represent a risk factor. [18]

Recurrent Majocchi granulomas may be linked with chemotherapy-induced neutropenia. [19]

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

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Physical Examination

Majocchi granuloma or granuloma trichophyticum may develop on any hair-bearing area, but most often, the scalp, face, [21] forearms, hands, and legs are involved. It may sometimes involve the pubic area. [22] A superficial perifollicular form of Majocchi granuloma on the scrotum, caused by T rubrum, has been described. [23]

Majocchi granuloma may begin as solitary or multiple well-circumscribed oval patches or as indistinct scaling ones. Majocchi granuloma evolves into perifollicular papulopustules and nodules with or without background erythema and scaling.

A plaque may demonstrate keloidal features, but these findings are unusual. Nodules are often clustered, but they can be solitary as well. Pressure does not result in pus exudation.

Unlike a kerion, granuloma trichophyticum does not become clinically suppurative until late in its course, unless secondarily impetigo develops.

If the cutaneous features of Majocchi granuloma are associated with the use of topical steroids, they may be affected by the complications of topical steroid therapy, including poikiloderma with atrophy and telangiectasia, papular rosacea, or a hypopigmented patch suggestive of indeterminate leprosy.

Majocchi granuloma may rarely resemble Kaposi sarcoma, as it does in patients with AIDS or lymphocytoma cutis. In such cases, Majocchi granulomas are painful and appear as blue-red papules and nodules on an erythematous base. [24]

Majocchi granuloma may appear as a persistent cutaneous plaque in wrestlers and may be considered a type of tinea corporis gladiatorum. [25]

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Complications

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

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