By Gary M. White, MD
Majocchi granuloma represents a dermatophyte infection of dermal and/or subcutaneous tissue.
The two main clinical patterns are 1) perifollicular erythematous papules in normal hosts and 2) nodules or plaques in immunocompromised hosts. For a related condition, see deep dermatophytosis. Typical locations include shaved legs, scalp, the occluded skin under a watch and in locations of topical steroid use (e.g., for tinea that was thought to represent eczema). Usually one sees grouped follicular papules in a larger area of erythema. The edge may have the typical "active" border of tinea.
A KOH preparation is usually positive, although it may be negative if a topical antifungal agent has recently been used. A biopsy will show perifollicular suppurative or granulomatous inflammation. Special stains will show the organisms. Fungal culture may also be done, but takes longer.
In the normal host, topical antifungal therapy may be tried, but oral therapy is often needed to reach down into the follicle. Typical approaches include terbinafine (250 mg Qday for 3-6 weeks) or itraconazole (e.g., 200 mg BID for 7 days and repeated in one month if necessary).
In the immunocompromised patient, oral antifungal therapy until complete clearing is in order.
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