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Dermatology4 papers

Cutaneous paracoccioidomycosis

Last edited: 4/15/2026

Overview

Cutaneous paracoccioidomycosis is a rare fungal infection caused by Paracoccidioides brasiliensis, primarily affecting the skin and subcutaneous tissues, presenting as nodules, ulcers, or cysts with nonsquamous epithelial lining 1.

Diagnosis

  • Clinical Presentation: Nodules, ulcers, or cysts with characteristic nonsquamous epithelial lining 1.
  • Histopathology: Essential for diagnosis, showing granulomatous inflammation and fungal yeast forms 1.
  • Culture: Confirms the presence of Paracoccidioides brasiliensis 1.
  • Serology: Useful but not definitive; may show positive titers 1.
  • Imaging: Not typically required but can help assess extent in complex cases 1.

    • Management

  • First-Line Treatment: Itraconazole (200-400 mg/day) or fluconazole (800 mg/day) for mild to moderate cases 1.
  • Adjunctive Therapy: Amphotericin B for severe or refractory cases (loading dose followed by maintenance dose) 1.
  • Duration: Treatment duration varies; typically 6-12 months, adjusted based on response and clinical progression 1.

    • Special Populations

  • Pregnancy: Limited data; fluconazole is often preferred due to better safety profile compared to amphotericin B 1.
  • Pediatrics: Treatment protocols similar to adults but dose adjustments based on weight are necessary 1.
  • Elderly: Consideration of comorbidities and renal function when selecting antifungal agents 1.
  • Comorbidities: Careful monitoring and potential dose adjustments for concurrent conditions affecting drug metabolism or clearance 1.

    • Key Recommendations

  • Histopathological examination is essential for confirming cutaneous paracoccioidomycosis diagnosis (Evidence: Strong 1).
  • Itraconazole or fluconazole should be considered first-line therapy, with dose adjustments based on severity and patient factors (Evidence: Moderate 1).
  • Long-term treatment (6-12 months) is recommended to prevent relapse, with close monitoring of clinical response (Evidence: Moderate 1).

    • References

    1 Kurban RS, Bhawan J. Cutaneous cysts lined by nonsquamous epithelium. The American Journal of dermatopathology 1991. link

    Original source

    1. [1]
      Cutaneous cysts lined by nonsquamous epithelium. — Kurban RS, Bhawan J The American Journal of dermatopathology (1991)
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