Majocchi Granuloma Treatment & Management

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

Medical Care

Systemic antifungal treatment is preferred in both patients who are immunocompetent and in those who are immunocompromised. Treatment should last at least 4-6 weeks. Oral terbinafine has been used worldwide for Majocchi granuloma. [5, 22, 25, 30, 31] The administration of systemic terbinafine for 6 weeks is the best treatment option in a patient with a transplanted kidney and Majocchi granuloma.

Oral antifungals are usually necessary because topical agents alone are not effective. For example, systemic antifungal medication is the best option for patients who are immunocompromised.

Physicians should avoid the use of compound products containing a potent topical steroid. Physicians should not use potent topical steroids to treat possible dermatophytic infections. Combination products such as betamethasone dipropionate with clotrimazole 1% cream should be used with care or not at all. The authors do not favor the use of such products in children younger than 12 years. If such medications are used in adolescents, the authors suggest doing so for only 2 weeks. Similarly, physicians should apply topical steroids with occlusion only when they are confident that the eruption is not a dermatophytosis, because this treatment may predispose the patient to Majocchi granuloma.

To the authors' knowledge, no specific data about treating immunocompromised patients with Majocchi granuloma exist. The treatment of secondary bacterial infections and the removal of any exacerbating factors (eg, topical steroid use, occlusion) are indicated.

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Prevention

The avoidance of occlusion, topical steroids use, and leg shaving may prevent Majocchi granuloma.

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Long-Term Monitoring

The best objective measure in Majocchi granuloma is to observe the patient clinically. Culture and KOH specimens may be useful, but relapse occurs if the use of occlusion and topical steroids continues or is reinitiated.

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