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Successful treatment of cutaneous botryomycosis with a combination of minocycline and topical heat therapy.

Ishibashi M, Numata Y, Tagami H, Aiba S - Case Rep Dermatol (2012)

Bottom Line: We employed topical heat therapy and oral minocycline.The lesions became flattened and pigmented after 1 month.We consider that this simple treatment can be an effective and harmless complementary therapy for cutaneous botryomycosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Tohoku University Hospital, Sendai, Japan.

ABSTRACT
Cutaneous botryomycosis is a chronic focal infection characterized by a granulomatous inflammatory response to bacterial pathogens such as Staphylococcus aureus. Treatment requires antibiotic therapy and may also require surgical debridement. We employed topical heat therapy and oral minocycline. The lesions became flattened and pigmented after 1 month. We consider that this simple treatment can be an effective and harmless complementary therapy for cutaneous botryomycosis.

No MeSH data available.


Related in: MedlinePlus

Four months after the initial therapy.
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Figure 3: Four months after the initial therapy.

Mentions: A 53-year-old Japanese woman with a 6-year history of bronchial asthmatic attacks for which she occasionally used budesonide inhalation presented with a 3-month history of asymptomatic, scattered, red papules on the dorsum of the right foot (fig. 1). She denied any preceding trauma or surgical procedures at this site. The lesions gradually increased in size despite the tentative application of a topical corticosteroid. Thus, suspecting infectious granulomatous lesions, in addition to bacterial and fungal cultures we surgically removed one of the red papules for histopathological studies. Histopathologically, the papule showed the presence of basophilic bacterial granules surrounded by eosinophilic amorphous materials, constituting a typical Splendore-Hoeppli phenomenon in the mid-dermis [1] (fig. 2). The bacteriological culture of a part of the biopsy specimen yielded a colony of Staphylococcus aureus, whereas no other growth for fungi or actinomycetes could be observed. The results of the laboratory investigations excluded any risk factors such as diabetes mellitus, collagen disease or HIV infection. There was also no history of alcoholism. Despite the prolonged budesonide inhalation for bronchial asthma in the past, her neutrophil phagocytotic function and immunological parameters such as IgG levels and CD4 count were found to be all within normal limits. Based on these results, we made a diagnosis of cutaneous botryomycosis caused by S. aureus. Since the patient was allergic to a variety of drugs containing β-lactam antibiotics, we started oral administration of minocycline at a dose of 200 mg/day together with topical heat therapy, using a commercially available, disposable pocket warmer. She applied the pack daily as long as possible, taking care not to cause a burn injury. With this treatment, we noticed substantial clinical improvement of the lesions after 1 month, and the treatment was continued for another 4 months until all lesions became flattened and pigmented (fig. 3). There was no subsequent relapse in the following 8 months.


Successful treatment of cutaneous botryomycosis with a combination of minocycline and topical heat therapy.

Ishibashi M, Numata Y, Tagami H, Aiba S - Case Rep Dermatol (2012)

Four months after the initial therapy.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3369419&req=5

Figure 3: Four months after the initial therapy.
Mentions: A 53-year-old Japanese woman with a 6-year history of bronchial asthmatic attacks for which she occasionally used budesonide inhalation presented with a 3-month history of asymptomatic, scattered, red papules on the dorsum of the right foot (fig. 1). She denied any preceding trauma or surgical procedures at this site. The lesions gradually increased in size despite the tentative application of a topical corticosteroid. Thus, suspecting infectious granulomatous lesions, in addition to bacterial and fungal cultures we surgically removed one of the red papules for histopathological studies. Histopathologically, the papule showed the presence of basophilic bacterial granules surrounded by eosinophilic amorphous materials, constituting a typical Splendore-Hoeppli phenomenon in the mid-dermis [1] (fig. 2). The bacteriological culture of a part of the biopsy specimen yielded a colony of Staphylococcus aureus, whereas no other growth for fungi or actinomycetes could be observed. The results of the laboratory investigations excluded any risk factors such as diabetes mellitus, collagen disease or HIV infection. There was also no history of alcoholism. Despite the prolonged budesonide inhalation for bronchial asthma in the past, her neutrophil phagocytotic function and immunological parameters such as IgG levels and CD4 count were found to be all within normal limits. Based on these results, we made a diagnosis of cutaneous botryomycosis caused by S. aureus. Since the patient was allergic to a variety of drugs containing β-lactam antibiotics, we started oral administration of minocycline at a dose of 200 mg/day together with topical heat therapy, using a commercially available, disposable pocket warmer. She applied the pack daily as long as possible, taking care not to cause a burn injury. With this treatment, we noticed substantial clinical improvement of the lesions after 1 month, and the treatment was continued for another 4 months until all lesions became flattened and pigmented (fig. 3). There was no subsequent relapse in the following 8 months.

Bottom Line: We employed topical heat therapy and oral minocycline.The lesions became flattened and pigmented after 1 month.We consider that this simple treatment can be an effective and harmless complementary therapy for cutaneous botryomycosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Tohoku University Hospital, Sendai, Japan.

ABSTRACT
Cutaneous botryomycosis is a chronic focal infection characterized by a granulomatous inflammatory response to bacterial pathogens such as Staphylococcus aureus. Treatment requires antibiotic therapy and may also require surgical debridement. We employed topical heat therapy and oral minocycline. The lesions became flattened and pigmented after 1 month. We consider that this simple treatment can be an effective and harmless complementary therapy for cutaneous botryomycosis.

No MeSH data available.


Related in: MedlinePlus