Lobomycosis, also known as Jorge Lobo’s disease, is a rare chronic fungal infection that primarily affects the skin and subcutaneous tissues. It is named after the Brazilian dermatologist Jorge Lobo, who first described the disease in the 1930s.
Lobomycosis is caused by the fungus Lacazia loboi. This fungus is unique and not closely related to other well-known fungal pathogens. Lobomycosis usually presents as skin nodules and plaques, which can be single or multiple and often appear on exposed body parts such as the arms and legs.
The disease typically progresses slowly and is not generally life-threatening, but it can lead to disfigurement and complications if left untreated.
Epidemiology
Lobomycosis is most often associated with individuals who live or work in endemic regions, particularly those who have close contact with contaminated water sources, such as rivers or swamps.
Unlike some other infectious diseases, lobomycosis does not show significant seasonal variation in its incidence. It can affect individuals at any time of the year.
Anatomy
Pathophysiology
Lobomycosis typically progresses slowly over years or decades, with the skin nodules and plaques gradually increasing in size and number. The infection is generally confined to the skin and subcutaneous tissues and does not typically affect internal organs.
The host’s immune response to the fungal infection is characterized by granulomatous inflammation. Granulomas are aggregates of immune cells, including macrophages, lymphocytes, and giant cells, that form in response to the presence of the fungus. These granulomas contribute to the characteristic nodular appearance of the skin lesions.
Once the fungus enters the skin, it forms a chronic, granulomatous infection primarily in the dermis and subcutaneous tissues. This results in the characteristic skin nodules and plaques associated with the disease.
Etiology
Lobomycosis is caused by the fungus Lacazia loboi. This fungus is unique and distinct from many other fungal pathogens. It belongs to the order Onygenales and the family Onygenaceae.
Lacazia loboi is a dimorphic fungus and it exists in two different forms: a yeast-like form and a filamentous form. In the host, it primarily appears as yeast-like cells.
Genetics
Prognostic Factors
The size, location, and number of skin lesions can affect the prognosis. Smaller and isolated lesions may have a more favorable prognosis compared to larger, extensive, or multiple lesions.
The patient’s overall immune status and immune response to the fungal infection may impact the course of the disease. A well-functioning immune system may be more effective in controlling the infection.
The choice of treatment and its effectiveness can influence the prognosis. Antifungal medications, such as itraconazole or clofazimine, are commonly used to manage lobomycosis. The duration of treatment and the patient’s response to therapy are essential factors to consider.
Clinical History
Age Group:
Lobomycosis is most reported in adults. It often presents in individuals who have had prolonged exposure to the environmental sources of the fungus Lacazia loboi.
While lobomycosis can affect individuals of all ages, it is relatively rare in children. This could be due to differences in behavior, exposure patterns, or immune responses between adults and children.
Physical Examination
The physician will begin by closely inspecting the skin for any visible skin lesions, nodules, plaques, or other abnormalities. They will note the location, number, size, and distribution of skin lesions.
Lobomycosis lesions often appear as nodules or plaques, which can be raised and warty in appearance.
The physician will examine the color and texture of the lesions, as well as their borders and whether they are ulcerated.
They will assess if the lesions are painless or if the patient experiences any discomfort or tenderness. Palpation helps determine the depth and extent of the lesions within the skin and subcutaneous tissues.
The physician will consider other skin conditions that may have a similar appearance, such as leishmaniasis, mycetoma, bacterial infections, and other fungal infections.
Age group
Associated comorbidity
The open ulcers and nodules in lobomycosis lesions can serve as entry points for secondary bacterial infections. These infections can complicate the condition, leading to increased inflammation, pain, and slower healing of the affected areas.
The disfiguring nature of lobomycosis, especially when it affects visible body parts, can lead to psychological distress and emotional challenges for affected individuals. This may result in depression, anxiety, and reduced quality of life.
In cases where the disease leads to extensive skin involvement or severe tissue damage, there may be limitations in physical functioning, particularly if lesions affect the hands, feet, or joints.
The cosmetic impact and physical symptoms of lobomycosis can significantly reduce an individual’s overall quality of life. The disfigurement and discomfort may affect daily activities and social interactions.
Associated activity
Acuity of presentation
Lobomycosis lesions typically appear as small, painless nodules or plaques on the skin. These initial skin changes are usually indolent, with a slow and subtle onset.
In many cases, especially in the early stages, lobomycosis is asymptomatic, and affected individuals may not experience any symptoms other than the presence of skin lesions. This can lead to delayed diagnosis and treatment.
Over time, the skin nodules and plaques slowly enlarge and can become warty or verrucous in appearance.
Lobomycosis lesions are typically non-pruritic and non-tender. While some individuals may eventually experience mild discomfort or pain as the lesions grow or become ulcerated, these symptoms are not usually a prominent feature of the disease.
Differential Diagnoses
Mycetoma: Mycetoma is a chronic, granulomatous infection that can affect the skin and subcutaneous tissues, like lobomycosis.
Leishmaniasis: Cutaneous leishmaniasis can present with skin nodules, ulcers, and plaques that may resemble lobomycosis lesions. It is caused by protozoa of the Leishmania species.
Bacterial Infections: Certain bacterial infections, such as atypical mycobacterial infections or nontuberculous mycobacterial infections, can lead to skin nodules, abscesses, and granulomas that might mimic the appearance of lobomycosis.
Sporotrichosis: Sporotrichosis is a fungal infection caused by the Sporothrix schenckii fungus. It can manifest as skin nodules, ulcers, and plaques, particularly in the lymphocutaneous form, which may resemble lobomycosis.
Cutaneous Leptospirosis: Leptospirosis can occasionally lead to skin manifestations, such as erythematous nodules or plaques, which might be considered in the differential diagnosis.
Skin Tumors: Benign and malignant skin tumors can sometimes mimic the appearance of lobomycosis nodules. A biopsy may be needed to distinguish between tumors and lobomycosis.
Pyogenic Granuloma: Pyogenic granulomas are non-infectious, rapidly growing skin lesions that can be confused with lobomycosis. They are typically vascular in nature and often bleed easily.
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Antifungal Medications: The primary medical treatment for lobomycosis involves the use of antifungal medications. Itraconazole is the most prescribed antifungal for this purpose. Clofazimine, an antimycobacterial drug, may also be used in combination with itraconazole.
Prolonged Therapy: Treatment with antifungal medications is typically prolonged, often lasting for several months to years, depending on the severity of the disease. The duration of treatment may vary from one patient to another.
Surgical Treatment: Surgical excision of the lobomycosis lesions may be considered, particularly in cases with large, disfiguring, or ulcerated lesions. Surgical removal can help improve cosmetic outcomes and reduce the risk of secondary bacterial infections.
Reconstructive Surgery: In cases where the surgical excision results in extensive tissue loss, reconstructive surgery may be required to repair and restore the affected areas.
Supportive Care: Patients with ulcerated lesions may require wound care to promote healing and prevent infection.
Discomfort or pain associated with the lesions may require symptomatic treatment, such as pain medications.
Psychological Support: Given the potential disfigurement and the impact on the patient’s psychological well-being, counseling and psychological support may be beneficial to help individuals cope with the emotional and social challenges associated with lobomycosis.
Avoid Skin Injuries: Traumatic inoculation of the fungus into the skin is believed to be a potential mode of transmission. Therefore, it’s essential to take precautions to avoid skin injuries, cuts, or abrasions when engaging in activities that may expose individuals to the fungus.Â
Protective Clothing: When participating in outdoor activities or work that involves contact with soil, water, or vegetation in endemic areas, wearing protective clothing, such as long-sleeved shirts, long pants, and gloves, can help reduce the risk of fungal exposure.Â
Personal Hygiene: Maintaining good personal hygiene practices, such as regular handwashing, can reduce the risk of potential contamination with fungal spores.Â
Environmental Awareness: Individuals in endemic areas should be aware of their surroundings and any potential sources of exposure to contaminated water, soil, or plant material. Avoiding contact with these sources may reduce the risk of acquiring the infection.Â
Use of Antimicrobial agents
Clofazimine: It is an antimicrobial drug that has been used in the treatment of various conditions, including leprosy, mycobacterial infections, and some other skin disorders. Clofazimine exhibits antifungal properties and has shown effectiveness against certain fungal pathogens, including Lacazia loboi, the causative agent of lobomycosis.
Use of Antifungal <a class="wpil_keyword_link" href="https://medtigo.com/drugs/" title="drugs" data-wpil-keyword-link="linked">drugs</a>
Itraconazole: It is a broad-spectrum antifungal drug that inhibits the growth of various fungi, including Lacazia loboi, the causative agent of lobomycosis. It acts by interfering with the fungal cell membrane and inhibiting the synthesis of ergosterol, a key component of fungal cell walls.Itraconazole is one of the primary antifungal medications used in the treatment of lobomycosis. It is typically considered the first-line antifungal treatment for lobomycosis, and it is administered orally to inhibit the growth of the causative fungus, Lacazia loboi. Â
Posaconazole: Triazole antifungal agents include posaconazole. By suppressing the enzyme lanosterol 14-alpha-demethylase and sterol precursor buildup, it prevents the formation of ergosterol.Â
Surgical Excision: This involves the removal of lobomycosis lesions, which can include nodules, plaques, or ulcers. Surgical excision aims to improve the cosmetic appearance of the affected area and reduce the risk of secondary bacterial infections. It is important to perform the excision with an adequate margin of healthy tissue to minimize the risk of disease recurrence.Â
Reconstructive Surgery: Surgical excision results in extensive tissue loss, reconstructive surgery may be necessary to repair and restore the affected areas. This can help improve the cosmetic outcome and may be particularly important for lesions in cosmetically sensitive areas.Â
Skin Grafting: Skin grafting may be considered when excised lesions leave significant defects that cannot be closed by primary closure. In this procedure, a piece of healthy skin is transplanted from one area of the body to cover the excised area.Â
use-of-phases-in-managing-lobomycosis
Diagnosis Phase: A thorough physical examination, with a focus on the skin and subcutaneous tissues, is conducted to assess the characteristic nodules, plaques, or lesions associated with lobomycosis.Â
Histopathological Examination: To confirm the diagnosis, a skin biopsy is typically performed. The tissue sample is examined histopathologically to identify the presence of granulomas containing yeast-like cells, a key diagnostic feature.Â
Treatment Phase: The primary medical treatment for lobomycosis involves the use of antifungal medications. Itraconazole is commonly prescribed and may be combined with clofazimine. Â
Surgical Intervention: Surgical excision of lesions may be considered, particularly for large, disfiguring, or ulcerated lesions. Reconstructive surgery or skin grafting may be required in cases with extensive tissue loss.Â
Supportive Care: Supportive care may involve wound care for ulcerated lesions, pain management, and psychological support to help individuals cope with the emotional and social challenges associated with the condition.Â
Monitoring Phase: Regular follow-up appointments are essential to monitor the patient’s progress, assess treatment response, and make necessary adjustments to the treatment plan.Â
Follow-up Phase: Long-Term Monitoring: Patients with lobomycosis require long-term follow-up to monitor for disease recurrence and assess the need for continued treatment.Â
Medication
Future Trends
Media Gallary
References
Lobomycosis: epidemiology, clinical presentation, and management options – PMC (nih.gov)
Lobomycosis, also known as Jorge Lobo’s disease, is a rare chronic fungal infection that primarily affects the skin and subcutaneous tissues. It is named after the Brazilian dermatologist Jorge Lobo, who first described the disease in the 1930s.
Lobomycosis is caused by the fungus Lacazia loboi. This fungus is unique and not closely related to other well-known fungal pathogens. Lobomycosis usually presents as skin nodules and plaques, which can be single or multiple and often appear on exposed body parts such as the arms and legs.
The disease typically progresses slowly and is not generally life-threatening, but it can lead to disfigurement and complications if left untreated.
Lobomycosis is most often associated with individuals who live or work in endemic regions, particularly those who have close contact with contaminated water sources, such as rivers or swamps.
Unlike some other infectious diseases, lobomycosis does not show significant seasonal variation in its incidence. It can affect individuals at any time of the year.
Lobomycosis typically progresses slowly over years or decades, with the skin nodules and plaques gradually increasing in size and number. The infection is generally confined to the skin and subcutaneous tissues and does not typically affect internal organs.
The host’s immune response to the fungal infection is characterized by granulomatous inflammation. Granulomas are aggregates of immune cells, including macrophages, lymphocytes, and giant cells, that form in response to the presence of the fungus. These granulomas contribute to the characteristic nodular appearance of the skin lesions.
Once the fungus enters the skin, it forms a chronic, granulomatous infection primarily in the dermis and subcutaneous tissues. This results in the characteristic skin nodules and plaques associated with the disease.
Lobomycosis is caused by the fungus Lacazia loboi. This fungus is unique and distinct from many other fungal pathogens. It belongs to the order Onygenales and the family Onygenaceae.
Lacazia loboi is a dimorphic fungus and it exists in two different forms: a yeast-like form and a filamentous form. In the host, it primarily appears as yeast-like cells.
The size, location, and number of skin lesions can affect the prognosis. Smaller and isolated lesions may have a more favorable prognosis compared to larger, extensive, or multiple lesions.
The patient’s overall immune status and immune response to the fungal infection may impact the course of the disease. A well-functioning immune system may be more effective in controlling the infection.
The choice of treatment and its effectiveness can influence the prognosis. Antifungal medications, such as itraconazole or clofazimine, are commonly used to manage lobomycosis. The duration of treatment and the patient’s response to therapy are essential factors to consider.
Age Group:
Lobomycosis is most reported in adults. It often presents in individuals who have had prolonged exposure to the environmental sources of the fungus Lacazia loboi.
While lobomycosis can affect individuals of all ages, it is relatively rare in children. This could be due to differences in behavior, exposure patterns, or immune responses between adults and children.
The physician will begin by closely inspecting the skin for any visible skin lesions, nodules, plaques, or other abnormalities. They will note the location, number, size, and distribution of skin lesions.
Lobomycosis lesions often appear as nodules or plaques, which can be raised and warty in appearance.
The physician will examine the color and texture of the lesions, as well as their borders and whether they are ulcerated.
They will assess if the lesions are painless or if the patient experiences any discomfort or tenderness. Palpation helps determine the depth and extent of the lesions within the skin and subcutaneous tissues.
The physician will consider other skin conditions that may have a similar appearance, such as leishmaniasis, mycetoma, bacterial infections, and other fungal infections.
The open ulcers and nodules in lobomycosis lesions can serve as entry points for secondary bacterial infections. These infections can complicate the condition, leading to increased inflammation, pain, and slower healing of the affected areas.
The disfiguring nature of lobomycosis, especially when it affects visible body parts, can lead to psychological distress and emotional challenges for affected individuals. This may result in depression, anxiety, and reduced quality of life.
In cases where the disease leads to extensive skin involvement or severe tissue damage, there may be limitations in physical functioning, particularly if lesions affect the hands, feet, or joints.
The cosmetic impact and physical symptoms of lobomycosis can significantly reduce an individual’s overall quality of life. The disfigurement and discomfort may affect daily activities and social interactions.
Lobomycosis lesions typically appear as small, painless nodules or plaques on the skin. These initial skin changes are usually indolent, with a slow and subtle onset.
In many cases, especially in the early stages, lobomycosis is asymptomatic, and affected individuals may not experience any symptoms other than the presence of skin lesions. This can lead to delayed diagnosis and treatment.
Over time, the skin nodules and plaques slowly enlarge and can become warty or verrucous in appearance.
Lobomycosis lesions are typically non-pruritic and non-tender. While some individuals may eventually experience mild discomfort or pain as the lesions grow or become ulcerated, these symptoms are not usually a prominent feature of the disease.
Mycetoma: Mycetoma is a chronic, granulomatous infection that can affect the skin and subcutaneous tissues, like lobomycosis.
Leishmaniasis: Cutaneous leishmaniasis can present with skin nodules, ulcers, and plaques that may resemble lobomycosis lesions. It is caused by protozoa of the Leishmania species.
Bacterial Infections: Certain bacterial infections, such as atypical mycobacterial infections or nontuberculous mycobacterial infections, can lead to skin nodules, abscesses, and granulomas that might mimic the appearance of lobomycosis.
Sporotrichosis: Sporotrichosis is a fungal infection caused by the Sporothrix schenckii fungus. It can manifest as skin nodules, ulcers, and plaques, particularly in the lymphocutaneous form, which may resemble lobomycosis.
Cutaneous Leptospirosis: Leptospirosis can occasionally lead to skin manifestations, such as erythematous nodules or plaques, which might be considered in the differential diagnosis.
Skin Tumors: Benign and malignant skin tumors can sometimes mimic the appearance of lobomycosis nodules. A biopsy may be needed to distinguish between tumors and lobomycosis.
Pyogenic Granuloma: Pyogenic granulomas are non-infectious, rapidly growing skin lesions that can be confused with lobomycosis. They are typically vascular in nature and often bleed easily.
Antifungal Medications: The primary medical treatment for lobomycosis involves the use of antifungal medications. Itraconazole is the most prescribed antifungal for this purpose. Clofazimine, an antimycobacterial drug, may also be used in combination with itraconazole.
Prolonged Therapy: Treatment with antifungal medications is typically prolonged, often lasting for several months to years, depending on the severity of the disease. The duration of treatment may vary from one patient to another.
Surgical Treatment: Surgical excision of the lobomycosis lesions may be considered, particularly in cases with large, disfiguring, or ulcerated lesions. Surgical removal can help improve cosmetic outcomes and reduce the risk of secondary bacterial infections.
Reconstructive Surgery: In cases where the surgical excision results in extensive tissue loss, reconstructive surgery may be required to repair and restore the affected areas.
Supportive Care: Patients with ulcerated lesions may require wound care to promote healing and prevent infection.
Discomfort or pain associated with the lesions may require symptomatic treatment, such as pain medications.
Psychological Support: Given the potential disfigurement and the impact on the patient’s psychological well-being, counseling and psychological support may be beneficial to help individuals cope with the emotional and social challenges associated with lobomycosis.
Dermatology, General
Avoid Skin Injuries: Traumatic inoculation of the fungus into the skin is believed to be a potential mode of transmission. Therefore, it’s essential to take precautions to avoid skin injuries, cuts, or abrasions when engaging in activities that may expose individuals to the fungus.Â
Protective Clothing: When participating in outdoor activities or work that involves contact with soil, water, or vegetation in endemic areas, wearing protective clothing, such as long-sleeved shirts, long pants, and gloves, can help reduce the risk of fungal exposure.Â
Personal Hygiene: Maintaining good personal hygiene practices, such as regular handwashing, can reduce the risk of potential contamination with fungal spores.Â
Environmental Awareness: Individuals in endemic areas should be aware of their surroundings and any potential sources of exposure to contaminated water, soil, or plant material. Avoiding contact with these sources may reduce the risk of acquiring the infection.Â
Dermatology, General
Clofazimine: It is an antimicrobial drug that has been used in the treatment of various conditions, including leprosy, mycobacterial infections, and some other skin disorders. Clofazimine exhibits antifungal properties and has shown effectiveness against certain fungal pathogens, including Lacazia loboi, the causative agent of lobomycosis.
Itraconazole: It is a broad-spectrum antifungal drug that inhibits the growth of various fungi, including Lacazia loboi, the causative agent of lobomycosis. It acts by interfering with the fungal cell membrane and inhibiting the synthesis of ergosterol, a key component of fungal cell walls.Itraconazole is one of the primary antifungal medications used in the treatment of lobomycosis. It is typically considered the first-line antifungal treatment for lobomycosis, and it is administered orally to inhibit the growth of the causative fungus, Lacazia loboi. Â
Posaconazole: Triazole antifungal agents include posaconazole. By suppressing the enzyme lanosterol 14-alpha-demethylase and sterol precursor buildup, it prevents the formation of ergosterol.Â
Dermatology, General
Surgery, General
Surgical Excision: This involves the removal of lobomycosis lesions, which can include nodules, plaques, or ulcers. Surgical excision aims to improve the cosmetic appearance of the affected area and reduce the risk of secondary bacterial infections. It is important to perform the excision with an adequate margin of healthy tissue to minimize the risk of disease recurrence.Â
Reconstructive Surgery: Surgical excision results in extensive tissue loss, reconstructive surgery may be necessary to repair and restore the affected areas. This can help improve the cosmetic outcome and may be particularly important for lesions in cosmetically sensitive areas.Â
Skin Grafting: Skin grafting may be considered when excised lesions leave significant defects that cannot be closed by primary closure. In this procedure, a piece of healthy skin is transplanted from one area of the body to cover the excised area.Â
Dermatology, General
Diagnosis Phase: A thorough physical examination, with a focus on the skin and subcutaneous tissues, is conducted to assess the characteristic nodules, plaques, or lesions associated with lobomycosis.Â
Histopathological Examination: To confirm the diagnosis, a skin biopsy is typically performed. The tissue sample is examined histopathologically to identify the presence of granulomas containing yeast-like cells, a key diagnostic feature.Â
Treatment Phase: The primary medical treatment for lobomycosis involves the use of antifungal medications. Itraconazole is commonly prescribed and may be combined with clofazimine. Â
Surgical Intervention: Surgical excision of lesions may be considered, particularly for large, disfiguring, or ulcerated lesions. Reconstructive surgery or skin grafting may be required in cases with extensive tissue loss.Â
Supportive Care: Supportive care may involve wound care for ulcerated lesions, pain management, and psychological support to help individuals cope with the emotional and social challenges associated with the condition.Â
Monitoring Phase: Regular follow-up appointments are essential to monitor the patient’s progress, assess treatment response, and make necessary adjustments to the treatment plan.Â
Follow-up Phase: Long-Term Monitoring: Patients with lobomycosis require long-term follow-up to monitor for disease recurrence and assess the need for continued treatment.Â
Lobomycosis: epidemiology, clinical presentation, and management options – PMC (nih.gov)
Lobomycosis — DermNet (dermnetnz.org)
medtigo
Lobomycosis
Updated :
November 6, 2023
Lobomycosis, also known as Jorge Lobo’s disease, is a rare chronic fungal infection that primarily affects the skin and subcutaneous tissues. It is named after the Brazilian dermatologist Jorge Lobo, who first described the disease in the 1930s.
Lobomycosis is caused by the fungus Lacazia loboi. This fungus is unique and not closely related to other well-known fungal pathogens. Lobomycosis usually presents as skin nodules and plaques, which can be single or multiple and often appear on exposed body parts such as the arms and legs.
The disease typically progresses slowly and is not generally life-threatening, but it can lead to disfigurement and complications if left untreated.
Lobomycosis is most often associated with individuals who live or work in endemic regions, particularly those who have close contact with contaminated water sources, such as rivers or swamps.
Unlike some other infectious diseases, lobomycosis does not show significant seasonal variation in its incidence. It can affect individuals at any time of the year.
Lobomycosis typically progresses slowly over years or decades, with the skin nodules and plaques gradually increasing in size and number. The infection is generally confined to the skin and subcutaneous tissues and does not typically affect internal organs.
The host’s immune response to the fungal infection is characterized by granulomatous inflammation. Granulomas are aggregates of immune cells, including macrophages, lymphocytes, and giant cells, that form in response to the presence of the fungus. These granulomas contribute to the characteristic nodular appearance of the skin lesions.
Once the fungus enters the skin, it forms a chronic, granulomatous infection primarily in the dermis and subcutaneous tissues. This results in the characteristic skin nodules and plaques associated with the disease.
Lobomycosis is caused by the fungus Lacazia loboi. This fungus is unique and distinct from many other fungal pathogens. It belongs to the order Onygenales and the family Onygenaceae.
Lacazia loboi is a dimorphic fungus and it exists in two different forms: a yeast-like form and a filamentous form. In the host, it primarily appears as yeast-like cells.
The size, location, and number of skin lesions can affect the prognosis. Smaller and isolated lesions may have a more favorable prognosis compared to larger, extensive, or multiple lesions.
The patient’s overall immune status and immune response to the fungal infection may impact the course of the disease. A well-functioning immune system may be more effective in controlling the infection.
The choice of treatment and its effectiveness can influence the prognosis. Antifungal medications, such as itraconazole or clofazimine, are commonly used to manage lobomycosis. The duration of treatment and the patient’s response to therapy are essential factors to consider.
Age Group:
Lobomycosis is most reported in adults. It often presents in individuals who have had prolonged exposure to the environmental sources of the fungus Lacazia loboi.
While lobomycosis can affect individuals of all ages, it is relatively rare in children. This could be due to differences in behavior, exposure patterns, or immune responses between adults and children.
The physician will begin by closely inspecting the skin for any visible skin lesions, nodules, plaques, or other abnormalities. They will note the location, number, size, and distribution of skin lesions.
Lobomycosis lesions often appear as nodules or plaques, which can be raised and warty in appearance.
The physician will examine the color and texture of the lesions, as well as their borders and whether they are ulcerated.
They will assess if the lesions are painless or if the patient experiences any discomfort or tenderness. Palpation helps determine the depth and extent of the lesions within the skin and subcutaneous tissues.
The physician will consider other skin conditions that may have a similar appearance, such as leishmaniasis, mycetoma, bacterial infections, and other fungal infections.
The open ulcers and nodules in lobomycosis lesions can serve as entry points for secondary bacterial infections. These infections can complicate the condition, leading to increased inflammation, pain, and slower healing of the affected areas.
The disfiguring nature of lobomycosis, especially when it affects visible body parts, can lead to psychological distress and emotional challenges for affected individuals. This may result in depression, anxiety, and reduced quality of life.
In cases where the disease leads to extensive skin involvement or severe tissue damage, there may be limitations in physical functioning, particularly if lesions affect the hands, feet, or joints.
The cosmetic impact and physical symptoms of lobomycosis can significantly reduce an individual’s overall quality of life. The disfigurement and discomfort may affect daily activities and social interactions.
Lobomycosis lesions typically appear as small, painless nodules or plaques on the skin. These initial skin changes are usually indolent, with a slow and subtle onset.
In many cases, especially in the early stages, lobomycosis is asymptomatic, and affected individuals may not experience any symptoms other than the presence of skin lesions. This can lead to delayed diagnosis and treatment.
Over time, the skin nodules and plaques slowly enlarge and can become warty or verrucous in appearance.
Lobomycosis lesions are typically non-pruritic and non-tender. While some individuals may eventually experience mild discomfort or pain as the lesions grow or become ulcerated, these symptoms are not usually a prominent feature of the disease.
Mycetoma: Mycetoma is a chronic, granulomatous infection that can affect the skin and subcutaneous tissues, like lobomycosis.
Leishmaniasis: Cutaneous leishmaniasis can present with skin nodules, ulcers, and plaques that may resemble lobomycosis lesions. It is caused by protozoa of the Leishmania species.
Bacterial Infections: Certain bacterial infections, such as atypical mycobacterial infections or nontuberculous mycobacterial infections, can lead to skin nodules, abscesses, and granulomas that might mimic the appearance of lobomycosis.
Sporotrichosis: Sporotrichosis is a fungal infection caused by the Sporothrix schenckii fungus. It can manifest as skin nodules, ulcers, and plaques, particularly in the lymphocutaneous form, which may resemble lobomycosis.
Cutaneous Leptospirosis: Leptospirosis can occasionally lead to skin manifestations, such as erythematous nodules or plaques, which might be considered in the differential diagnosis.
Skin Tumors: Benign and malignant skin tumors can sometimes mimic the appearance of lobomycosis nodules. A biopsy may be needed to distinguish between tumors and lobomycosis.
Pyogenic Granuloma: Pyogenic granulomas are non-infectious, rapidly growing skin lesions that can be confused with lobomycosis. They are typically vascular in nature and often bleed easily.
Antifungal Medications: The primary medical treatment for lobomycosis involves the use of antifungal medications. Itraconazole is the most prescribed antifungal for this purpose. Clofazimine, an antimycobacterial drug, may also be used in combination with itraconazole.
Prolonged Therapy: Treatment with antifungal medications is typically prolonged, often lasting for several months to years, depending on the severity of the disease. The duration of treatment may vary from one patient to another.
Surgical Treatment: Surgical excision of the lobomycosis lesions may be considered, particularly in cases with large, disfiguring, or ulcerated lesions. Surgical removal can help improve cosmetic outcomes and reduce the risk of secondary bacterial infections.
Reconstructive Surgery: In cases where the surgical excision results in extensive tissue loss, reconstructive surgery may be required to repair and restore the affected areas.
Supportive Care: Patients with ulcerated lesions may require wound care to promote healing and prevent infection.
Discomfort or pain associated with the lesions may require symptomatic treatment, such as pain medications.
Psychological Support: Given the potential disfigurement and the impact on the patient’s psychological well-being, counseling and psychological support may be beneficial to help individuals cope with the emotional and social challenges associated with lobomycosis.
Dermatology, General
Avoid Skin Injuries: Traumatic inoculation of the fungus into the skin is believed to be a potential mode of transmission. Therefore, it’s essential to take precautions to avoid skin injuries, cuts, or abrasions when engaging in activities that may expose individuals to the fungus.Â
Protective Clothing: When participating in outdoor activities or work that involves contact with soil, water, or vegetation in endemic areas, wearing protective clothing, such as long-sleeved shirts, long pants, and gloves, can help reduce the risk of fungal exposure.Â
Personal Hygiene: Maintaining good personal hygiene practices, such as regular handwashing, can reduce the risk of potential contamination with fungal spores.Â
Environmental Awareness: Individuals in endemic areas should be aware of their surroundings and any potential sources of exposure to contaminated water, soil, or plant material. Avoiding contact with these sources may reduce the risk of acquiring the infection.Â
Dermatology, General
Clofazimine: It is an antimicrobial drug that has been used in the treatment of various conditions, including leprosy, mycobacterial infections, and some other skin disorders. Clofazimine exhibits antifungal properties and has shown effectiveness against certain fungal pathogens, including Lacazia loboi, the causative agent of lobomycosis.
Itraconazole: It is a broad-spectrum antifungal drug that inhibits the growth of various fungi, including Lacazia loboi, the causative agent of lobomycosis. It acts by interfering with the fungal cell membrane and inhibiting the synthesis of ergosterol, a key component of fungal cell walls.Itraconazole is one of the primary antifungal medications used in the treatment of lobomycosis. It is typically considered the first-line antifungal treatment for lobomycosis, and it is administered orally to inhibit the growth of the causative fungus, Lacazia loboi. Â
Posaconazole: Triazole antifungal agents include posaconazole. By suppressing the enzyme lanosterol 14-alpha-demethylase and sterol precursor buildup, it prevents the formation of ergosterol.Â
Dermatology, General
Surgery, General
Surgical Excision: This involves the removal of lobomycosis lesions, which can include nodules, plaques, or ulcers. Surgical excision aims to improve the cosmetic appearance of the affected area and reduce the risk of secondary bacterial infections. It is important to perform the excision with an adequate margin of healthy tissue to minimize the risk of disease recurrence.Â
Reconstructive Surgery: Surgical excision results in extensive tissue loss, reconstructive surgery may be necessary to repair and restore the affected areas. This can help improve the cosmetic outcome and may be particularly important for lesions in cosmetically sensitive areas.Â
Skin Grafting: Skin grafting may be considered when excised lesions leave significant defects that cannot be closed by primary closure. In this procedure, a piece of healthy skin is transplanted from one area of the body to cover the excised area.Â
Dermatology, General
Diagnosis Phase: A thorough physical examination, with a focus on the skin and subcutaneous tissues, is conducted to assess the characteristic nodules, plaques, or lesions associated with lobomycosis.Â
Histopathological Examination: To confirm the diagnosis, a skin biopsy is typically performed. The tissue sample is examined histopathologically to identify the presence of granulomas containing yeast-like cells, a key diagnostic feature.Â
Treatment Phase: The primary medical treatment for lobomycosis involves the use of antifungal medications. Itraconazole is commonly prescribed and may be combined with clofazimine. Â
Surgical Intervention: Surgical excision of lesions may be considered, particularly for large, disfiguring, or ulcerated lesions. Reconstructive surgery or skin grafting may be required in cases with extensive tissue loss.Â
Supportive Care: Supportive care may involve wound care for ulcerated lesions, pain management, and psychological support to help individuals cope with the emotional and social challenges associated with the condition.Â
Monitoring Phase: Regular follow-up appointments are essential to monitor the patient’s progress, assess treatment response, and make necessary adjustments to the treatment plan.Â
Follow-up Phase: Long-Term Monitoring: Patients with lobomycosis require long-term follow-up to monitor for disease recurrence and assess the need for continued treatment.Â
Lobomycosis: epidemiology, clinical presentation, and management options – PMC (nih.gov)
Lobomycosis — DermNet (dermnetnz.org)
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