Lymphocutaneous sporotrichosis treated with three different modalities

S Banerjee¹ , AK Jaiswal²

¹ Dept. of Dermatology & STD, Base Hospital, Lucknow, India
² Dept. of Dermatology & STD, Base Hospital, Barrackpore, India

Correspondence Address:
S Banerjee
Dept. of Dermatology & STD, Base Hospital, Lucknow
India

Introduction

Sporotrichosis is a chronic lymphatic subcutaneous fungal infection caused by Sporothrix schenckii.[1] It is characterized by nodular lesions of cutaneous and subcutaneous tissues with involvement of adjacent lymphatics usually as a consequence of traumatic implantation of the causative organism. Various modalities of treatment are available for combating this deep fungal infection.[2] Here we report our experience in use of three different treatment modalities in a series of cases of lymphocutaneous sporotrichosis.

Case no.1

A 21-year-old serving soldier presented with non-healing ulcerated growth over right ankle with multiple linear subcutaneous swellings over right calf of one-month duration.

Dermatological examination revealed 04 cm x 02 cm ulcerated plaque with verrucous friable surface and serosanguinous discharge over right ankle. Multiple hard non-tender subcutaneous nodules unattached to the overlying skin were present in a linear distribution along the right calf proximal to the ulcerated plaque. Skin biopsy was consistent with sporotrichosis. The individual was treated with cap itraconzole 200 mg twice a day, to which he responded well within six weeks of therapy.

Case no. 2

A 24-year-old serving soldier, resident of Bihar presented with linearly distributed subcutaneous nodules and ulcers over dorsum of right hand of one year duration.

Dermatological examination revealed multiple discrete, firm, nontender subcutaneous nodules arranged linearly over dorsum of index finger of right hand upto the wrist joint [Figure - 1].

Skin biopsy was consistent with sporotrichosis. The patient was put on thermotherapy to which he responded with complete healing of lesions within eight weeks of therapy.

Case No.3

A 33-year-old serving soldier presented with non-healing ulcer over dorsum of left foot and multiple painful subcutaneous swellings over left calf and thigh of one-month duration.

Dermatological examination revealed a shallow ulcer with surface showing adherent crusts over dorsum of left third finger.

Multiple linear subcutaneous swellings were present over left calf and thigh proximal to the ulcer [Figure - 2]. Few of the nodules had broker down at places with clear serous discharge. Skir biopsy was consistent with sporotrichosis. The patient was put on saturated solution of potassiurr iodide 10 ml thrice a day. Within four weeks o initiation of therapy the cutaneous lesions healec completely, leaving behind residual atrophic scars [Figure:3].

Discussion

With the discovery of newer systemic antifungals a host of therapeutic modalities are available for treating sporotrichosis.[4] A series o sporotrichosis cases were treated with three different modalities and their comparative efficacy was evaluated.

In our first case though the response to itraconazole therapy was good but it had its own drawbacks. Besides being a costly and protractec therapy, it has to be used cautiously because of it; hepatic and endocrine side effects.[5]

The second patient treated with thermotherapy also showed a fairly good response but then the duration of therapy was the longest and also the penetration and elimination of fungus from deeper tissues could not be guaranteed, being an exogenous source of therapy. The patient treated with SSKI not only showed an excellent response but it also proved to be the best regimen as far duration and side effects were concerned.

To conclude we feel that SSKI still remains the standard treatment for sporotrichosis. It is simple to prepare, cost effective and has minimal side effects. This is in agreement with most of the contemporary studies.[6],[7],[8] The newer systemic antifungals should only be used in patients who do not respond/intolerant to SSKI or having systemic involvement.

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