Majocchi Granuloma

What is Majocchi granuloma?  This rash was named for a famous Italian dermatologist Majocchi, and granuloma implies that the rash and inflammation is in the deeper layers of the skin.

How does one get Majocchi granuloma?  This is a VERY common condition, seen at all ages.  The rash starts when a person has a superficial fungal infection of the skin.  Generally, fungus grows only on the superficial outer layers of the skin (epidermis). In this condition, the fungus invades the deeper layers of the skin.  The most common reason that fungus spreads to the deeper layers of the skin is topical steroids.  Patients apply topical steroids to a rash, not realizing that a rash is fungus.  The steroid may seem to help for a few days.  However, over time, it causes the fungus to spread like wildfire and allows the fungus to invade the deeper layer of the skin, the dermis.

How does it look?   Usually, it has individual little bumps and less in rings than classic ringworm.  Often the bumps will have a pimply look with a white head on them.

How is it treated?   Unfortunately, once there is fungus in the deeper layer of the skin, topical antifungals won’t work.  Generally, we prescribe oral terbinafine for 2-4 weeks daily, to eradicate the infection.

Any complicating factors?   Sometimes patients will have another rash as well.  Say, psoriasis or eczema, that has been infected with fungus.  In these cases, we have to stop all topical steroids will treating with an oral antifungal.  Then, after all the fungus is dead, we resume any topical steroids that are being used to treat a primary rash.

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