Cutaneous Cryptococcus Treatment & Management

Updated: Nov 18, 2019
  • Author: Aziz Khan, MD, MBBS; Chief Editor: Dirk M Elston, MD  more...
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Treatment

Medical Care

Disseminated infection should always be ruled out in patients with cutaneous cryptococcosis. CNS involvement is treated with intravenous amphotericin B combined with flucytosine, followed by oral fluconazole. In immunosuppressed patients, the initial treatments are similar; however, long-term maintenance therapy with fluconazole may be required. In immunocompromised patients with pulmonary infection, lumbar puncture should be performed to rule out meningitis. Patients with fungemia or dissemination (involvement of at least two noncontiguous sites or evidence of high fungal burden based on cryptococcal antigen titer ≥1:512) are treated as CNS disease. In immunocompetent patients, nondisseminated, non-CNS Cryptococcus infection can be treated with oral fluconazole for 3-6 months or with itraconazole for 6-12 months.

There have been no studies performed to evaluate the effectiveness of different treatment modalities for immunocompetent patients with primary cutaneous cryptococcosis. As per published case reports, fluconazole at a dose of 200-800 mg/day for a duration ranging from 2 weeks to 6 months or itraconazole at a dose of 100-400 mg/day for 3-6 months has been tried with good success rates. Success was achieved in 20 of 21 patients, with the only treatment failure reported with fluconazole at 400 mg/dat for 3 months. [17]

Patients with acute, disseminated disease should be treated in an inpatient setting.

Also, see the following related clinical guidelines:

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Surgical Care

Surgical excision or cryotherapy may play a role in primary cutaneous infections. [9]

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Consultations

Consultation with an infectious disease specialist should be obtained for all patients to evaluate for disseminated disease. As warranted, consultations should be obtained from a pulmonologist or neurologist, among others, depending on the extent of disease involvement.

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Prevention

Avoidance of areas that may be contaminated by pigeon droppings, especially for immunosuppressed persons, can reduce the likelihood of infection. Early detection of HIV and the initiation of antiretroviral therapy to prevent severe immunodeficiency remains the most effective intervention to decrease the burden of cryptococcal infection.

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