Majocchi Granuloma Workup

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

Approach Considerations

Majocchi granuloma seen together with severe dermatophytosis suggests assessment of immune function may be beneficial, possibly leading to a discussion of AIDS. [28]

Next:

Laboratory Studies

A potassium hydroxide (KOH) preparation of scales and pustules usually reveals no hyphal elements. Samples from a contiguous dermatophyte infection, if present, may stain positive.

Previous
Next:

Other Tests

Gram stains, calcofluor stains, scale cultures, and exudate or tissue biopsy samples may reveal hyphae when the KOH test result is negative. In general, tissue homogenate cultures are more sensitive than special stains.

Previous
Next:

Histologic Findings

Majocchi granuloma is essentially a deep suppurative and granulomatous folliculitis. The earliest sign is hyphal invasion in the cornified keratinocytes of the hair follicle, which produces a suppurative folliculitis with the rupture of the hair follicle and the spillage of its contents into the dermis. This rupture causes a granulomatous dermal response. Such nodules may heal with fibrosis. Periodic acid-Schiff or Gomori methenamine-silver stains may reveal fungal hyphae in the tissue, surrounded by a foreign body granulomatous reaction. Use of optical brighteners may enhance detection of fungal elements in the deep dermis and may be more sensitive than with periodic acid-Schiff (PAS) staining. [29]

Previous