it is a fungal infection in which epidermal part of skin is much affected.

1. CASE PRESENTATION
ON
MAJOCCHI GRANULOMA
BY
E.VIKRANT REDDY
Y16PHD1105

2. NAME : MR.XXX
AGE/SEX:19/M
WEIGHT: 55KG
DEPARTMENT: DERMATOLOGY
H.NO.340/16
D.O.A: 09/12/18
D.O.D:12/12/18
REVIEWON: 18/12/18

3. ADMISSION COMPLICATION:
PATIENT CAME WITH A CHEIF COMPLAINT OF
SKIN RASHES
BURNING SENSATION
RED COLOUR PATCHES ON LEGS
BLEED FROM LESION
NONPRURITIC SOLITARY
PLAQUES

4. PERSONAL HISTORY
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5. HISTORY OF PRESENT ILLINESS:
PATIENT IS SUFFERING FOR SKIN RASHES SEENS 2
WEEK. ITCHING ASSOCIATED WITH REDNESS AND
SCARRING AND ALOPECIA CONDITION

6. • PAST MEDICAL HISTORY
• MEDICALCONDITION : NON HYPERTENSIVE, NON ASTHMATIC AND
NON DIABETIC, TINEA CAPITIS(SKIN INFECTION ON SCALP),
SUPPURATIVE FOLLICULITIS (PUS ON HAIR FOLLICAL)
• SURGERIES: NO SURGERICAL HISTORY
• PASTMEDICTION HISTORY : STEROID OINTMENT FOR
DERMALPROBLEM , HAD USED IMMUNOSUPPRESSIVE THERPY FOR
LEUKEMIA

7. • INVESTIGATION
• HISTOPATHOLOGICAL TEST WAS DONE
• PRESENCE OF TRICHOPHYTON VIOLACEUM (BACTERIA)
• A POTASSIUM HYDROXIDE (KOH) PREPARATION OF SCALES AND
PUSTULES NO REVEALS HYPHAL ELEMENTS IN STAIN
• GRAM STAINS +VE

8. 6 DNS IV SOLUTION 100ML/HR 9/12/18
s.no DRUGS REGIMEN START
DATE
END
DATE
1
Bentamethason
e dipropionate
withclotrimazole
1%
BID 9/12/18 12/12/18
2 Terbinafine(Lamisil) 250 MG 9/12/18 12/12/18
3 clotrimazole 10 MG TID 9/12/18 12/12/18
4 itraconazole 200MG / D 9/12/18 12/12/18
5 PANTOPRAZOLE 40MG BID 9/12/18 12/12/18

9. SOAP ANALYSIS
• SUBJECTIVE EVIDENCE
SKIN RASHES , BURNING SENSATION ,RED
COLOUR PATCHES ON LEGS,
BLEED FROM LESION, NONPRURITIC SOLITARY
PLAQUES FROM 2WEEKS
OBJECTIVE EVIDENCE: PRESENCE OF TRICHOPHYTON
VIOLACEUM (BACTERIA)
• A POTASSIUM HYDROXIDE (KOH) PREPARATION OF SCALES AND
PUSTULES NO REVEALS HYPHAL ELEMENTS IN STAIN
• GRAM STAINS +VE
ASSESSMENT

10. • PLANNING:
• CURRENT THERAPY:
• 1. BENTAMETHASONE DIPROPIONATE WITH CLOTRIMAZOL 1%
INDICATION: ANTI FUNGAL AGENT
2.TERBINAFINE (LAMISIL) 250MG/BID
INDICATION : ANTI FUNGAL AGENT
3 CLOTRIMAZOLE 10MG/TID
INDICATION: ANTI FUNGAL AGENT
4 ITRACONAZOLE 200MG/OD
INDICATION : ANTI FUNGAL AGENT
5.PANTOPRAZOLE 40MG/BID
INDICATION: PROTON PUMP INHIBITOR

11. JUSTIFICATION
SINCE THE PATIENT IS SUFFERING FROM FUNGAL INFECTION ,
BENTAMETHASONE DIPROPIONATE WITHCLOTRIMAZOLE 1% IS
GIVEN FOR RELIEVE INFECTION BECAUSE IT IS AN ANTI FUNGAL
CREAM AND WORKS AGAINST THE FUNGAL AGENTS . THE
CREAM SO MUCH MORE EFFICENCY AT SITE OF INFECTION
THE TERBINAFINE , CLOTRIMAZOLE , ITRACONAZOL ARE ALSO
ANTIFUNGAL DRUGS RELIEVE FROM FUNGAL AGENT
PANTAPRAZOLE IS AN ANTIULCER DRUGIN CLASS OF PROTON
PUMP INHIBITOR. IT WAS GIVEN TO TREAT THE GASTRIC
IRRITATION CAUSED BY DRUGS

12. ADVERSE EFFECT
1. BENTAMETHASONE DIPROPIONATE WITH CLOTRIMAZOL 1%: DRYNESS ,
IRRITATION
2.TERBINAFINE (LAMISIL) 250MG/BID: FATIGUE ,DEPRESSION ,
VOMITING
3 CLOTRIMAZOLE 10MG/TID : REDNESS , PEELING , STINGING
4 ITRACONAZOLE 200MG/OD : HEADACHE UPSET OF STOMACH ,
JOINT PAIN ,HAIR LOSS
5.PANTOPRAZOLE 40MG/BID : HEADACHE , DIARRHEA

13. • DRUG INTERACTION:
• SERIOUS-USE ALTERNATIVE: PANTOPRAZOLE+
ITRACONAZOLE
• MAJOR :
• CLOTRIMAZOLE + ITRACONAZOLE : CLOTRIMAZOLE WILL
DECREASE THE LEVEL OR EFFECT OF ITRACONAZOLE BY P-
GLYCOPROTEIN (MDR1) EFFLUX TRANSPORTER
• MINOR: ITRACONAZOLE + PANTOPRAZOLE: ITRACONAZOLE WILL
INCREASE THE LEVEL OR EFFECT OF PANTOPRAZOLE BY AFFECTING
HEPATIC / INTESTINAL ENZYME CYP3A4 METABOLISM

14. • PATIENT COUNSELLING
• REGARDING DRUGS
• TERBINAFINE: DISCONTINUE IF THE FOLLOWING DEVELOP
:LIVER DISEASE, NEUTROPENIA
• CLOTRIMAZOLE: CONTRA INDICATION FOR HYPER SENSITIVITY

15. • PREVENTION : THE AVOIDANCE OF OCCLUSION, TOPICAL
STREIODS USE AND LEG SHAVING MAY PREVENT MAJOCCHI
GRANULOMA

16. • REGARDING DISEASESSE: MAJOCCHI GRANULOMA CAN BE
DEFINED AS A DEEP FOLLICULITIS DUE TO A CUTANEOUS
DERMATOPHYTE INFECTION.MAJOCCHI GRANULOMA IS MOST
COMMONLY DUE TO TRICHOPHYTON RUBRUM INFECTION.
MAJOCCHI GRANULOMA TENDS TO OCCUR IN YOUNG WOMEN
WHO FREQUENTLY SHAVE THEIR LEGS, ALTHOUGH MAJOCCHI
GRANULOMA ALSO IS SEEN IN MEN.MAJOCCHI GRANULOMA
ALSO COMMONLY OCCURS AS A RESULT OF THE USE OF POTENT
TOPICAL STEROIDS ON UNSUSPECTED TINEA. MAJOCCHI
GRANULOMA IS ALSO KNOWN AS GRANULOMA

17. • PHARMACIST INTERVENTION:
• CLOTRIMAZOLE + ITRACONAZOLE : THE BENEFITES
OF TAKING THIS COMBINATION OF MEDICINES MAY
OUTWEIGH ANY RISKS ASSOCIATED WITH
THERAPEUTIC DUPLICATION . SOME ONE OF THEM
SHOULD BE REMOVED