History

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.

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.

Differential Diagnoses

Wilson JW, Plunkett OA, Gregersen A. Nodular granulomatous perifolliculitis of the legs caused by Trichophyton rubrum. AMA Arch Derm Syphilol. 1954 Mar. 63(3):258-77. [QxMD MEDLINE Link].
Coelho WS, Diniz LM, Sousa Filho JB, Castro CM. [Case for diagnosis. Granuloma trichophyticum (Majocchi's granuloma)]. An Bras Dermatol. 2009 Jan-Feb. 84(1):85-6. [QxMD MEDLINE Link].
Meinhof W, Hornstein OP, Scheiffarth F. [Multiple subcutaneous Trichophyton rubrum abscesses. Pathomorphosis of a generalized superficial tinea due to impaired immunological resistance]. Hautarzt. 1976 Jul. 27(7):318-27. [QxMD MEDLINE Link].
Radentz WH, Yanase DJ. Papular lesions in an immunocompromised patient. Trichophyton rubrum granulomas (Majocchi's granuloma). Arch Dermatol. 1993 Sep. 129(9):1189-90, 1192-3. [QxMD MEDLINE Link].
André NF, Canato M, Zanatta DA, Gomes IF, Abage KT, Carvalho VO. Majocchi granuloma on a child's face. Dermatol Online J. 2018 Dec 15. 24 (12):[QxMD MEDLINE Link].
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Kurian A, Haber RM. Tinea corporis gladiatorum presenting as a majocchi granuloma. ISRN Dermatol. 2011. 2011:767589. [QxMD MEDLINE Link]. [Full Text].
Lyra MR, Muniz Álvarez B, Lanziano AL, Imbeth MAA, Sá AM, Cuzzi T, et al. Exfoliative erythroderma and palmoplantar hyperkeratosis associated with Majocchi's granuloma by Trichophyton tonsurans in a patient with AIDS. Rev Iberoam Micol. 2017 Apr 24. [QxMD MEDLINE Link].
Mayser PA. [Majocchi granuloma. Advantages of optical brightener staining in a case report]. Hautarzt. 2014 Aug. 65(8):721-4. [QxMD MEDLINE Link].
Bressan AL, Silva RS, Fonseca JC, Alves Mde F. Majocchi's granuloma. An Bras Dermatol. 2011 Aug. 86(4):797-8. [QxMD MEDLINE Link].
Gupta AK, Prussick R, Sibbald RG, Knowles SR. Terbinafine in the treatment of Majocchi's granuloma. Int J Dermatol. 1995 Jul. 34(7):489. [QxMD MEDLINE Link].
Yang Y, Zhang Z, Gu Y, et al. Majocchi's granuloma on the scalp of a 55-year-old female successfully treated with terbinafine. Dermatol Ther. 2022 Apr. 35 (4):e15304. [QxMD MEDLINE Link].
Shi L, Wu Q, Yang J, et al. ALA-PDT successfully treated Majocchi's granuloma by directly killing Trichophyton tonsurans and recruiting T lymphocytes. Photodiagnosis Photodyn Ther. 2021 Sep. 35:102328. [QxMD MEDLINE Link].
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Nakajima H. [The pathophysiology and defense mechanism against superficial and subcutaneous fungal infection]. Nippon Ishinkin Gakkai Zasshi. 2005. 46(1):5-9. [QxMD MEDLINE Link].
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. 2006 Mar. 45(3):215-9. [QxMD MEDLINE Link].
Steiner UC, Trüeb RM, Schad K, Kamarashev J, Koch S, French LE, et al. Trichophyton rubrum-induced Majocchi's Granuloma in a heart transplant recipient. A therapeutic challenge. J Dermatol Case Rep. 2012 Sep 28. 6(3):70-2. [QxMD MEDLINE Link]. [Full Text].
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Media Gallery

Pseudomonas folliculitis. Courtesy of Hon Pak, MD.

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Author

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Professor of Pediatrics, Professor of Medicine, Rutgers New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, New York Academy of Medicine, Royal College of Physicians of Edinburgh, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Coauthor(s)

Camila K Janniger, MD Clinical Professor of Dermatology, Clinical Associate Professor of Pediatrics, Chief of Pediatric Dermatology, Rutgers 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

Michael J Wells, MD, FAAD Dermatologic/Mohs Surgeon, The Surgery Center at Plano Dermatology

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

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

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

Disclosure: Nothing to disclose.

Additional Contributors

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

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Olegas Ceburkovas, MD, to the development and writing of this article.

Majocchi Granuloma Clinical Presentation

History

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