What are the other Names for this Condition? (Also known as/Synonyms)

• Granuloma Trichophyticum
• MG (Majocchi Granuloma)

What is Majocchi Granuloma? (Definition/Background Information)

• Majocchi Granuloma (MG) is an uncommon infection of the hair follicles that is predominantly caused by dermatophytes, a large group of fungus, resulting in pus-filled skin lesions mostly on the lower extremities (limbs)
• The lesions may bleed and ulcerate, presenting pain and discomfort. The predisposing factors for Majocchi Granuloma include use of topical steroids prior to an accurate diagnosis, untreated chronic infections, and weak immune systems
• The condition is typically managed using oral antifungal medications. The outcomes of individuals with Majocchi Granuloma is usually good, but the condition may recur

Who gets Majocchi Granuloma? (Age and Sex Distribution)

• Majocchi Granuloma are generally observed in adults; children are rarely affected
• Both males and females are affected
• Worldwide, there is no racial or ethnic preference observed. However, most of the cases are reported from developing nations

What are the Risk Factors for Majocchi Granuloma? (Predisposing Factors)

The risk factors for Majocchi Granuloma include:

• Use of topical steroid creams without a proper diagnosis of the skin condition - it is the most important risk factor
• Fungal infection treated inappropriately using topical steroids resulting in tinea incognita
• Chronic infections that are not treated adequately
• Use of immunosuppressants
• Immunocompromised individuals
• Minor trauma to the skin, such as while shaving
• Tropical (hot-wet) climate

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Majocchi Granuloma? (Etiology)

Majocchi Granuloma is caused by a fungal infection of the hair follicles. The infection is deep, penetrating into the dermis (skin layer below the epidermis), and involving the subcutaneous tissues.

• In over 95% of the cases, dermatophytic fungus (genus Trichophyton) are implicated; while, in the remaining 5% of the cases, it may occur from aspergillus species (i.e., non-dermatophytic fungi)
• The main causative dermatophytic fungi is Trichophyton rubrum, with others in the list being:
• Trichophyton mentagrophytes
• Trichophyton tonsurans
• Trichophyton violaceum
• Epidermophyton floccosum

Use of a prescription cream containing both a potent steroid and an antifungal, when used on a fungal infection, is a common cause of Majocchi Granuloma.

The infection may spread to others through direct contact or via shared items such as bedding and towels.

What are the Signs and Symptoms of Majocchi Granuloma?

The signs and symptoms of Majocchi Granuloma may vary from one individual to another and may be mild or severe. It may include:

• Presence red skin lesions in the form of papules, nodules, or pustules
• Healthy individuals may present skin infection that is localized (focal) to the region in the form of papules
• Immunocompromised individuals may present deeper nodules that may cover large areas
• Scale formation may be noted around the lesions
• Bleeding, oozing of pus, and ulceration
• The condition can present, pain, irritation, and discomfort
• Most of the cases involve the lower leg, while lesions may be found at other sites such as the face too
• Fungal infection at other locations in the body, such as athlete’s foot or nail fungus, may be present

How is Majocchi Granuloma Diagnosed?

A diagnosis of Majocchi Granuloma may involve the following exams and procedures:

• Physical examination of the individual and medical history evaluation
• Blood tests and fungal culture
• Dermoscopy: Dermoscopy is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Skin biopsy: A skin tissue biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Majocchi Granuloma?

The possible complications due to Majocchi Granuloma include:

• Emotional stress due to cosmetic issues
• Superimposed bacterial infections
• Recurrence of the condition following treatment
• Treatment complications and side effects

How is Majocchi Granuloma Treated?

The treatment measures available for Majocchi Granuloma include:

• Oral antifungal medications, usually with terbinafine, form the treatment of choice
• Topical applications for the fungus are not known to be effective, since the infection is deep into the subcutaneous tissues

Regular follow up visits with the healthcare provider is important and recommended.

How can Majocchi Granuloma be Prevented?

Majocchi Granuloma may be prevented by considering the following steps:

• Complete the prescribed course of treatment for any infection
• Avoid self-medication of skin infections using topical applications such as steroidal creams
• Undertake early diagnosis and/or treatment of any condition causing poor immunity, where possible
• Avoid self-induced skin injury, where possible
• Maintain good body hygiene
• Treat any fungal infection immediately and prevent them from spreading to other regions of the body

What is the Prognosis of Majocchi Granuloma? (Outcomes/Resolutions)

• The prognosis of Majocchi Granuloma is generally good with adequate treatment
• In order to prevent its recurrence, the treatment has to be continued, even after all the signs of infection have ceased

Additional and Relevant Useful Information for Majocchi Granuloma:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/skin-disorders/