ABSTRACT
Sporotrichosis is a subcutaneous mycosis caused by Sporothrix complex, endemic in Abancay, Peru. Is acquired by traumatic inoculation with plant material. Common clinical presentations are lymphatic cutaneous and fixed cutaneous disease. We report 2 cases of fixed cutaneous sporotrichosis with granulomatous appearance. The first case was a patient of 65 years old with no risk factors and the second case was a 67 year old diabetic patient. Subjects underwent mycological culture with Sabouraud agar, with isolation of Sporothrix schenckii and clinical dignosis of fixed cutaneous sporotrichosis with granulomatous appearance. One patient received oral treatment with saturated solution of potassium iodide (SSKI) with a initial dose of 3 drops tid up to a maximum dose of 40 drops tid. Mycological and clinical cure was achieved after 2 months of treatment. We should consider the unusual clinical presentations of fixed cutaneous sporotrichosis with granulomatous appearance that present morphological and clinical features in diabetic and nondiabetic patients older than 60 years from endemic areas and communicate adequate response to treatment with SSKI in one case.
La esporotricosis es una micosis subcutánea ocasionada por el complejo Sporothrix, endémica en Abancay, Perú. Se adquiere por inoculación traumática con material vegetal. Las formas clínicas comúnmente descritas son la cutánea linfática y cutánea fija. Presentamos dos casos de pacientes adultos con una esporotricosis cutánea fija granulomatosa. El primer caso era una paciente de 65 años de edad, sin antecedentes de riesgo y el segundo era una paciente de 67 años, diabética. El diagnóstico se realizó por cultivo micológico aislándose Sporothrix schenckii. Un caso se trató con solución saturada de yoduro de potasio (SSKI), vía oral, alcanzando la cura micológica y clínica tras dos meses de tratamiento. La otra paciente no acudió a tratamiento. Se revisan las presentaciones clínicas inusuales de la esporotricosis cutánea fija y la forma granulomatosa que presenta características morfológicas y clínicas poco habituales en pacientes diabéticos y no diabéticos mayores de 60 años provenientes de zonas endémicas.
Subject(s)
Aged , Female , Humans , Granuloma/diagnosis , Sporotrichosis/diagnosis , Granuloma/drug therapy , Granuloma/microbiology , Potassium Iodide/administration & dosage , Sporotrichosis/drug therapy , Treatment OutcomeABSTRACT
Potassium iodide, as a saturated solution, is a valuable drug in the dermatologist's therapeutic arsenal and is useful for the treatment of different diseases due to its immunomodulatory features. However, its prescription has become increasingly less frequent in dermatology practice. Little knowledge about its exact mechanism of action, lack of interest from the pharmaceutical industry, the advent of new drugs, and the toxicity caused by the use of high doses of the drug are some possible explanations for that. Consequently, there are few scientific studies on the pharmacological aspects, dosage and efficacy of this drug. Also, there is no conventional standard on how to manipulate and prescribe the saturated solution of potassium iodide, which leads to unawareness of the exact amount of the salt being delivered in grams to patients. Considering that dosage is directly related to toxicity and the immunomodulatory features of this drug, it is essential to define the amount to be prescribed and to reduce it to a minimum effective dose in order to minimize the risks of intolerance and thus improve treatment adherence. This review is relevant due to the fact that the saturated solution of potassium iodide is often the only therapeutic choice available for the treatment of some infectious, inflammatory and immune-mediated dermatoses, no matter whether the reason is specific indication, failure of a previous therapy or cost-effectiveness.
Iodeto de potássio, sob a forma de solução saturada, é um valioso medicamento no arsenal terapêutico do dermatologista. É usado há mais de um século e útil para doenças de fisiopatologias diversas em virtude de seu caráter imunomodulador. Prescrevê-lo, entretanto, tem se tornado cada vez menos frequente na prática dermatológica. O pouco conhecimento sobre seu exato mecanismo de ação, o desinteresse da indústria farmacêutica com o advento de novos fármacos, além da toxicidade do medicamento pelas altas doses utilizadas são algumas das possíveis justificativas. Dessa forma, os estudos científicos envolvendo seus aspectos farmacológicos, posológicos e de eficácia são relativamente raros. Consequentemente, não se convencionou uma padronização na forma de manipular e prescrever a solução saturada de iodeto de potássio, o que causa um verdadeiro desconhecimento da dose exata em gramas do sal que está sendo fornecida aos pacientes. Ao considerar que a dose está diretamente relacionada toxicidade e o conhecimento da característica imunomoduladora dessa droga, é importante definir a quantidade a ser fornecida, reduzindo-a até a dose mínima eficaz, de forma a diminuir a intolerância e melhorar a adesão ao tratamento. A relevância do tema se deve ao fato da solução saturada de iodeto de potássio ser, muitas vezes, a única escolha na terapêutica disponível para o tratamento de algumas dermatoses de origem infecciosa, inflamatória ou imunomediada, quer por indicação específica, por falha de outro medicamento ou por seu custo acessível.
Subject(s)
Humans , Dermatologic Agents , Potassium Iodide , Skin Diseases/drug therapy , Dermatologic Agents/administration & dosage , Dermatologic Agents/adverse effects , Potassium Iodide/administration & dosage , Potassium Iodide/adverse effects , Thyroid Diseases/drug therapy , Thyroid Gland/drug effectsABSTRACT
Se informa el caso de un paciente de 75 años de edad, con dos lesiones nodulares ulceronecrótica, cercana al codo derecho, cuya histopatología presentó un cuadro de proceso granulamatoso supurativa. El cultivo para hongos fue positiva a Sporotrix schenikii. Se le administró itraconazol, 20 mg diarios, durante dos meses, sin respuesta favorable. Al cambiarse la terapia a yoduro de potasio, el cuadro remitió completamente. Se discuten las dificultades diagnósticas y terapéuticas.
Subject(s)
Humans , Male , Aged , Potassium Iodide/administration & dosage , Sporotrichosis/therapy , Itraconazole/administration & dosageSubject(s)
Humans , Antifungal Agents/therapeutic use , Dermatomycoses/drug therapy , Antifungal Agents/administration & dosage , Chromoblastomycosis/drug therapy , Mitosporic Fungi , Hyperthermia, Induced/statistics & numerical data , Mycetoma/drug therapy , Potassium Iodide/administration & dosage , Potassium Iodide/therapeutic use , Sporotrichosis/drug therapyABSTRACT
Chronic sporotrichosis granuloma of the skin is usually the result of non compliance with oral iodine therapy for whatever reason. Excision of the lesion, local iodine application with povidone iodide for six days and delayed primary skin grafting is presented as a quick, effective and acceptable alternative, if oral treatment is not tolerated. The ineffectiveness of local excision and grafting without adequate iodine therapy is demonstrated by this case
Subject(s)
Humans , Male , Middle Aged , Sporotrichosis/therapy , Granuloma/therapy , Iodides/administration & dosage , Administration, Oral , Administration, Topical , Combined Modality Therapy , Sporotrichosis/drug therapy , Sporotrichosis/surgery , Granuloma/drug therapy , Granuloma/surgery , Potassium Iodide/administration & dosage , Potassium Iodide/adverse effects , RecurrenceABSTRACT
A partir de la observación de quince casos de esporotricosis atendidos en la ciudad de Santa Fe (Argentina), se realiza una revisión del tema: ecología, fuentes de información, evolución de la casuística según áreas geográficas, diagnóstico micológico, formas clínicas cutáneas y sistémicas y alternativas terapéuticas. Se comunica la existencia de un foco endémico de la enfermedad en el Noroeste de la provincia de Santa Fe, entre los cazadores de armadillos (tatú mulita o Dasypus novemcinc-tus), siendo éste el segundo registro mundial de microendemia esporotricósica con similares características a lo que acontece en Uruguay
Subject(s)
Humans , Male , Adolescent , Adult , Middle Aged , Argentina , Itraconazole/administration & dosage , Ketoconazole/administration & dosage , Potassium Iodide/administration & dosage , Sporothrix/isolation & purification , Sporotrichosis/diagnosis , Diagnosis, Differential , Itraconazole/therapeutic use , Ketoconazole/therapeutic use , Potassium Iodide/therapeutic use , Sporothrix/pathogenicity , Sporotrichosis/drug therapy , Sporotrichosis/epidemiologyABSTRACT
Os autores fazem uma revisäo literária da esporotricose, dermatose que é muito freqüente em nosso meio, analisando aspectos históricos, epidemiológicos, etiopatogénicos, clínicos e de tratamento na infância. Säo apresentados dois casos de esporotricose em crianças