Majocchi’s Granuloma

If you have read any of my prior posts about fungus, you know there is one thing that I frequently emphasize.  Never treat fungus with a topical steroid. Topical steroids make fungus grow. Often fungus treated with topical steroid leads to Majocchi’s Granuloma.  Let’s learn a bit more about it today.

What is Majocchi’s 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’s 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 dermis layer of the skin.

How does it look?   Usually, it has individual little bumps in a serpiginous configuration.  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 while 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.

There are many common ways to pick up a fungal infection.  To when in doubt, treat with an antifungal first.  As a reminder, not all topical antifungals are made equal. There are two types of topical antifungals.  Fungistatic that slows the growth of fungus and fungicidal to actually kill fungus.  Always use a fungicidal antifungal like Lamisil cream OTC.  

To learn more about top places you can pick up fungus and more, see the articles below.

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