Elsevier

Clinics in Dermatology

Volume 30, Issue 4, July–August 2012, Pages 420-424
Clinics in Dermatology

Lobomycosis

https://doi.org/10.1016/j.clindermatol.2011.09.014Get rights and content

Abstract

Lobomycosis is a rare chronic fungal infection of the subcutaneous tissue found in South America, mainly in Brazil. It is caused by Lacazia loboi. Its clinical manifestations are dermal nodules, either lenticular or in plaques, and keloidlike lesions that can resemble nodular leprosy or leishmaniasis, other subcutaneous mycoses (sporotrychosis, chromomycosis, paracoccidioidomycosis), keloids, and malignant tumors. Diagnosis is made by the histopathological findings of the fungus. For treatment, surgical removal of the lesions, followed by itraconazole and clofazimine for disseminated lesions, has been used with variable results.

Section snippets

Clinical Features

Lobo disease is characterized by pleomorphic lesions. These may occur as variably sized dermal nodules, either lenticular or in plaques (Figure 1), which can be either hyper- or hypopigmented. The lesions are generally painless, although pruritus and dysesthesia have been occasionally described. Different types of lesions may be seen at various stages of disease progression.20, 21 Infiltrative lesions are often a feature of early disease and can simulate tuberculoid leprosy or burn scars,

Diagnosis

The clinical diagnosis is apparent to physicians who have seen previous cases of lobomycosis and the patient is known to reside in an endemic area; however, infiltrating plaque lesions and those with a keloidal aspect compromising the outer ears and associated with keloidal lesions in other body sites, can be confused with lepromatous leprosy or diffuse cutaneous leishmaniasis.4 Other diseases that should be ruled out when lesions have a verrucous, vegetating, or nodular aspect are

Treatment

No antifungal has been shown to be effective against Lacazia loboi yet. The optimal treatment for localized lesions is wide surgical excision, electrocauterization, or cryosurgery, ensuring that margins are free of the disease to avoid recurrence.4, 21 It is worth noting that instruments contaminated during operation can lead to reinfection.

The only treatment of choice for disseminated infection is chemotherapy. Clofazimine, with dosages of 100 and 200 mg daily, has been used in some studies,

Conclusions

In the dawn of molecular medicine, lobomycosis remains an obscure, emerging disease in humans that presents challenges that should stimulate research in its etiopathogenesis and transmission, as well as in the development of more effective treatment.

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