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Deep fungal infections of concern today
Author(s) -
Jacobs P.H.
Publication year - 1992
Publication title -
journal of the european academy of dermatology and venereology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.655
H-Index - 107
eISSN - 1468-3083
pISSN - 0926-9959
DOI - 10.1111/j.1468-3083.1992.tb00676.x
Subject(s) - itraconazole , sporotrichosis , medicine , blastomycosis , histoplasmosis , dermatology , ketoconazole , fungal disease , aspergillosis , disease , phaeohyphomycosis , antifungal , pathology , immunology
A wide variety of mycoses afflict patients in the West. Skin lesions are a common manifestation and so the patient may present first to the dermatologist. Over 100,000 new cases of coccidioidomycosis occur in the USA each year. Dissemination occurs in about 0.5% of patients with clinical disease. Skin lesions can take many forms. Samples and cultures should be handled with care because of the risk of spreading the infection. Itraconazole is likely to replace ketoconazole as the treatment of choice. Histoplasmosis is a systemic disease. Skin lesions again take a variety of forms. Mycological diagnosis may be possible without special stains. Itraconazole is the drug of choice and due to its negligible adverse effects can be used prophylactically. North American blastomycotic lesions, and the organisms responsible, both have a characteristic appearance. However, although the organisms are fairly easy to identify in some tissues, special stains may be needed to demonstrate them in the skin. Itraconazole is now the treatment of choice for blastomycosis dermatitidis. Systemic sporotrichosis is extremely rare. Cutaneous sporotrichosis appears both as a localized, and as lymphangitic form. The organism is easy to culture, but histological demonstration may be extremely difficult. Itraconazole is virtually 100% effective and in future will make all other treatments redundant. Almost all cases of disseminated aspergillosis occur in immunocompromised patients, particularly those treated with high‐dose steroids. Itraconazole is the only effective drug and may also be used prophylactically. The dermatologist may be the first physician to see patients with these mycoses and thus needs to be aware of the possible diagnoses and their implications. Itraconazole is now the treatment of choice and at last enables the physician to reduce both morbidity and mortality.