Majocchi granuloma

Author: Dr Maneka Gnanasegaram, Dermatology Registrar, Greenlane Hospital, Auckland, New Zealand, 2012.


What is Majocchi granuloma?

Majocchi granuloma is a deep and persistent suppurative folliculitis (hair follicle infection) caused by dermatophyte fungi (tinea).

What does Majocchi granuloma look like?

Majocchi granuloma presents with an irregular red, scaly plaque in which there are follicular papules, pustules and nodules. It is usually found on one lower leg.

Evidence for fungal infection may be found in other sites such as scaling on the sole of the foot (tinea pedis) or yellowed, irregular toenails (tinea unguium).

Majocchi granuloma

What is the cause of Majocchi granuloma?

Majocchi granuloma is most often caused by Trichophyton rubrum. Sometimes other fungi are found on culture, including:

  • Trichophyton mentagrophytes
  • Trichophyton violaceum
  • Epidermophyton floccosum.

Associated factors leading to deep follicular infection may include:

How is Majocchi granuloma diagnosed?

Suspicion is raised due to its clinical appearance.

To confirm the diagnosis, scrapings and hair samples may be taken from the affected area for microscopy and fungal culture (mycology). Granulomatous inflammation is found on skin biopsy.

What is the treatment for Majocchi granuloma?

The recommended treatment for Majocchi granuloma is a 4-6 week course of oral antifungal agent.

Topical antifungal agents may not be effective due to deep invasion of fungus into the hair follicle.

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References

  • Dermatology. Bolognia JL, Jorizzo JL, Rapini RP. Second edition. Mosby Elsevier

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