Sporotrichosis refractory to conventional treatment: therapeutic success with potassium iodide

Sporotrichosis is a subcutaneous mycosis caused by dimorphic fungi of the genus Sporothrix. The authors report a case of fixed cutaneous sporotrichosis with therapeutic failure after 18 months of itraconazole and terbinafine associated with cryosurgery. The patient was cured after the introduction of saturated potassium iodide solution. Sporothrix brasiliensis was the identified species, presenting a susceptibility profile to itraconazole and terbinafine. This fact suggests that therapeutic failure is probably related to the host-fungus interaction rather than drug resistance. It is possible that the immunomodulatory action of the saturated potassium iodide solution may have played an important role in curing this patient.     

Cutaneous sporotrichosis of face: polymorphism and reactivation after intralesional triamcinolone

Cutaneous sporotrichosis, a subcutaneous mycotic infection is caused by the saprophytic, dimorphic fungus Sporothrix schenckii. It commonly presents as lymphocutaneous or fixed cutaneous lesions involving the upper extremities with facial lesions being seen more often in children. The lesions are polymorphic. The therapeutic response to saturated solution of potassium iodide is almost diagnostic. We describe a culture-proven case of cutaneous sporotrichosis of the face mimicking lupus vulgaris initially and basal cell carcinoma later, who did not tolerate potassium iodide and failed to respond to treatment with fluconazole. The patient had reactivation of infection following an infiltration of the scar with triamcinolone acetonide injection. Various other aspects of these unusual phenomena are also discussed.     

孢子丝菌病药敏和治疗进展

孢子丝菌病是一种深部真菌病,其致病菌申克孢子丝菌为一种双相真菌,双相真菌的体外药敏试验至今仍无统一标准.饱和碘化钾溶液、伊曲康唑、特比萘芬为治疗孢子丝菌病的常用药物,临床中选择合适的抗真菌药物对治疗此病具有重要意义.体外药敏试验是评价抗真菌药物活性的重要方法,也是选择药物的依据之一.     

Hyalohyphomycosis masquerading as squamous cell carcinoma

A case of primary cutaneous hyalohyphomycosis in a healthy individual is presented. The initial clinical impression was keratoacanthoma or squamous cell carcinoma. Upon excision, the lesion proved to be an example of cutaneous hyalohyphomycosis due to an unidentified, non-pigmented fungal organism. The lesion was completely excised, and the patient was treated with saturated solution of potassium iodide. To date, there has been no evidence of recurrence. The clinical, histologic and mycologic aspects of hyalophyphomycosis are discussed.     

Potassium iodide remains the most effective therapy for cutaneous sporotrichosis

Sporotrichosis is a subcutaneous fungal infection caused by the dimorphic fungus Sporothrix schenckii. Itraconazole has largely replaced older therapies, but we present a case of lymphocutaneous sporotrichosis that failed to respond to an adequate course of itraconazole yet responded dramatically to treatment with saturated solution of potassium iodide (SSKI).     

Lymphocutaneous sporotrichosis treated with three different modalities

Three cases of lymphocutaneous sporotrichosis were treated with three different modalities and oral saturated solution of potassium iodide was found to be best modality.     

碘化钾与伊曲康唑联合治疗孢子丝菌病的实验研究

目的观察碘化钾与伊曲康唑单独用药和联合用药对实验性孢子丝菌感染的治疗作用。方法建立小鼠孢子丝菌皮内和系统感染模型,分别设立对照组、碘化钾组、伊曲康唑组及碘化钾和伊曲康唑联合用药组,检测各组真菌培养阳性率、组织中孢子数目及炎症浸润细胞的变化。结果与对照组比较,用药组皮内感染皮损中孢子数目减少,系统感染组织器官真菌培养阳性率降低,联合用药组与单独用药组上述两指标比较均有显著性差异。皮内感染三个用药组都可引起炎症细胞的浸润增加,联合用药组以巨噬细胞的增加尤为明显。结论碘化钾与伊曲康唑联合治疗小鼠孢子丝菌皮内感染和系统感染均优于两种药物单独应用。     

Usefulness of itraconazole for sporotrichosis in Japan: study of three cases and literature comparison of therapeutic effects before and after release on the market

Potassium iodide, itraconazole (ITCZ), and terbinafine are widely known as oral antifungal agents for the treatment of sporotrichosis. Although potassium iodide has been used as the antifungal agent of first choice in Japan due to its high efficacy, its use is not covered by the health insurance programs. In this report, we present the disease course of 3 patients with sporotrichosis in which ITCZ was remarkably effective. By reviewing cases reported in the past, we found sufficient therapeutic effects of ITCZ against sporotrichosis. We also conducted a simple comparison of the efficacy of ITCZ in clinical trials with that of its post-market release; finding the latter to be lower. This seems to be attributable to the problem of compliance or the administration method.     

伊曲康唑联合碘化钾治疗孢子丝菌病24例临床观察

目的观察伊曲康唑联合碘化钾治疗孢子丝菌病的疗效与安全性。方法采用随机对照、平行试验的方法,68例孢子丝菌病患者随机分为口服伊曲康唑组、口服碘化钾组以及联合用药组,治疗4周观察疗效及不良反应。结果联合用药组临床有效率为91.67%,显著高于单用伊曲康唑组(64.00%)及单用碘化钾组(54.55%);联合用药组真菌清除率为87.50%,显著高于单用伊曲康唑组(54.29%)及碘化钾组(48.49%),不良反应与对照组差异无著性。结论伊曲康唑联合碘化钾治疗孢子丝菌疗效明显优于单用药,安全性好。     

Potassium iodide in refractory,recurrent pediatric Sweet syndrome: Guidance in dosing and monitoring

We describe a 5‐month‐old boy with clinical and histopathologic presentation of Sweet syndrome. He responded to systemic corticosteroids, with multiple flares on tapering; potassium iodide was added, which provided complete resolution of Sweet syndrome. Potassium iodide has been used in only a few cases, and no standard dosage has been established in children. We discuss calculation of a pediatric dosage for potassium iodide in Sweet syndrome.     

Potassium iodide and the wolff-chaikoff effect: relevance for the dermatologist

The inhibition of organic binding of iodide in the thyroid gland by excess iodide, resulting in the cessation of thyroid hormone synthesis, is known as the Wolff-Chaikoff effect. This review explores the nature of the Wolff-Chaikoff effect, both in terms of its potential mechanisms and its relevance to dermatologists who use potassium iodide as a therapeutic agent.     

伊曲康唑联合疗法治疗4例深部真菌病临床观察

目的:观察伊曲康唑联合疗法治疗4例深部真菌病的疗效.方法:对3例孢子丝菌病、1例着色芽生菌病分别采用伊曲康唑口服加10%碘化钾口服,伊曲康唑口服加中药局部烫洗治疗.结果:4例患者全部治愈.结论:伊曲康唑联合疗法治疗深部真菌病有效.     

Dacryocystitis due to Sporothrix brasiliensis: a case report of a successful clinical and serological outcome with low‐dose potassium iodide treatment and oculoplastic surgery

Sporothrix brasiliensis is the main species of the S. schenckii complex implicated in the zoonotic epidemics of sporotrichosis in Rio de Janeiro, Brazil. Epidemiological features have been already described, such as zoonotic transmission by cats and increased frequency of atypical clinical aspects. The involvement of the face by contact with cats is common in childhood; as a result, ophthalmic manifestations have increased. We report a case of acute dacryocystitis in a 9‐year‐old girl. A calmodulin‐based molecular phylogeny was used to identify the agent as S. brasiliensis. This is a rare type of presentation, usually complicated with nasolacrimal duct occlusion. The patient was cured without sequelae after treatment with a low dose of saturated solution of potassium iodide and decompressive oculoplastic surgery. Therapeutic options and considerations of aetiological agents and serology are discussed.     

碘化钾治疗孢子丝菌病的实验研究

对不同免疫状态小鼠造成孢子丝菌实验性感染，观察碘化钾的治疗作用和病损发展过程中病原体与炎症浸润细胞的变化及两者间的关系。结果进一步证实碘化钾对孢子丝菌病的治疗作用与宿主的免疫力有关，并发现碘化钾具有促进巨噬细胞在感染部位的浸润和增强小鼠对孢子丝菌的抵抗力，还表明碘化钾对小鼠内脏感染无效，而对血源播散型皮肤感染的作用因小鼠的免疫状态而异。     

Sweet''s syndrome: a report on the use of potassium iodide

Eight cases of Sweet's syndrome are reported. Considerable variation in the clinical and the histological features was noted. The effectiveness of potassium iodide is confirmed. This therapy is a useful alternative to systemic steroids.     

Potassium iodide in erythema nodosum and other erythematous dermatoses

Potassium iodide therapy has a history of more than 150 years. It has been tried in many diseases in the past. However, with the development of modern medications indications for potassium iodide therapy are very limited. It is well known that potassium iodide is the drug of choice for sporotrichosis. Subacute nodular migratory panniculitis and erythema nodosum have also been treated successfully with this drug.     

Elephantine nose due to rhinoentomophthoromycosis

Rhinoentomophthoromycosis in an immunocompetent Indian male due to Basidiobolus species resulting in a huge (elephantine) nasal deformity, is reported. The diagnosis was done by demonstration of hyphae in direct tissue smear examination in potassium hydroxide, histopathological examination and by cultural characteristics. He showed an excellent response to oral potassium iodide solution.     

Cyclosporine A in the treatment of psoriasis: a clinical and mechanistic perspective

Cyclosporine A, a unique immunomodulatory agent, has been used increasingly over the last 5 years in the management of severe psoriasis. The remarkable efficacy of this drug coupled with its known immunosuppressive properties have enabled a further appreciation of the role of the immune system in the induction and maintenance of psoriatic plaques. Although acting primarily on T lymphocytes, there is also evidence for an effect of cyclosporine A on other constitutive cell types within the skin. The future use of systemically administered cyclosporine A in the treatment of psoriasis and other cutaneous diseases is dependent on the successful balance of efficacy and side-effect profile; namely, the dose-related problems of hypertension and nephrotoxicity. As a result of the toxicity encountered with systemically administered cyclosporine A, attempts to formulate a successful topical preparation for use in cutaneous disease are being made. The advent of cyclosporine A provides the dermatologist with a new therapeutic strategem in the management of psoriasis, although the long-term safety of such interventional therapy remains to be discerned.     

TREATMENT OF ERYTHEMATOUS DERMATOSES WITH POTASSIUM IODIDE

Forty-seven patients with various erythematous dermatoses were treated with systemic administration of potassium iodide. There were fifteen patients with erythema nodosum, ten with nodular vasculitis, fourteen with erythema multiforme, and eight with Sweet's syndrome. Potassium iodide was dramatically effective in a substantial number of cases. In responsive patients, improvement of the cutaneous changes was evident within a few days. The effect of the drug was impressive in patients with lesional tenderness, joint pains, and/or high fever. Relief of these subjective symptoms occurred within twenty-four hours. The possible mode of the action of potassium iodide and pathogenesis of erythematous dermatoses were also discussed.     

Subcutaneous Zygomycosis: A Report of One Case Responding Excellently to Potassium Iodide

Subcutaneous Zygomycosis is a rare opportunistic fungal infection caused by Basidiobolus ranarum. Though this entity is endemic in South India, limited numbers of cases have been reported from this part of the country. We report a case of subcutaneous zygomycosis in a 25 year old lady who presented with a nontender, firm to hard swelling over the upper-left arm. Finger was easily inserted below the indurated edge. Histopathology revealed suppurative granuloma with aseptate hyphae. Patient responded excellently to saturated solution of potassium iodide in subsequent visits.