Background
Majocchi granuloma can be defined as a deep folliculitis due to a cutaneous dermatophyte infection. [1] Majocchi granuloma is most commonly due to Trichophyton rubrum infection. Majocchi granuloma tends to occur in young women who frequently shave their legs, although Majocchi granuloma also is seen in men. [2] Majocchi granuloma also commonly occurs as a result of the use of potent topical steroids on unsuspected tinea. Majocchi granuloma is also known as granuloma trichophyticum.
Many species of dermatophytes can cause Majocchi granuloma. Today, Majocchi granuloma is usually due to T rubrum [3, 4] ; however, Trichophyton violaceum was the most common organism identified historically. Other causes of Majocchi granuloma include Trichophyton mentagrophytes and Epidermophyton floccosum. [5]
In 1883, Professor Domenico Majocchi (1849-1929) first described this disorder, he called granuloma tricofitico. [6] He is also credited with describing a type of chronic pigmented purpura: purpura annularis telangiectodes, which is commonly known as Majocchi disease. Majocchi, an important figure in Italian academic dermatology, was a professor of dermatology first at the University of Parma and later at the University of Bologna.
Also see the Medscape article Tinea Corporis.
Pathophysiology
The pathophysiology of the fungal infection and defense mechanisms against superficial dermatomycosis has been studied. [7] Two series of experimental infections of T mentagrophytes were made on the forearm of a male volunteer with topical steroid ointment and vehicle alone. Steroid ointment suppressed the immune reactions locally to produce little inflammatory reaction with abundant fungal elements (so-called atypical tinea) and a mixed cell granuloma.
While inflammatory tinea capitis or kerion is the result of a hypersensitivity reaction to a dermatophytic infection, Majocchi granuloma usually begins as a suppurative folliculitis and may culminate in a granulomatous reaction. [8] Nineteen cases of kerion of the scalp in children were evaluated. Histopathological findings demonstrated a spectrum from suppurative folliculitis to dense granulomatous infiltrates without a clear relationship with the clinical features.
Widespread trichophytic granulomas may occur in patients receiving immunosuppressive therapy for leukemia or lymphoma, autoimmune diseases, and post–organ transplantation. [9, 10, 11] However, these dermatophyte infections may also occur in patients with atopic dermatitis, probably because of their immunological susceptibility. [12]
Etiology
Majocchi granuloma is a foreign body granuloma most commonly caused by T rubrum.T violaceum was the most common organism identified historically.
Other causes of Majocchi granuloma include T mentagrophytes, [13] Trichophyton tonsurans, [10, 14] and E floccosum. [15] The fungal infections may be due to or linked with a widespread contiguous dermatophytosis, immunosuppression, and/or the use of topical steroids.
Epidemiology
To the authors' knowledge, no specific data on the incidence and prevalence of Majocchi granuloma exist. A patient was recently described in Brazil. [2]
Prognosis
Majocchi granuloma cure is expected with appropriate systemic antifungal therapy. To the authors' knowledge, no data about relapse rates or the complications of not treating Majocchi granuloma exist.
Patient Education
Patients should be educated about the cause of Majocchi granuloma, as well as the predisposing and exacerbating factors.
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Pseudomonas folliculitis. Courtesy of Hon Pak, MD.
