Cryosurgery as adjuvant therapy in cutaneous sporotrichosis

CLINICAL IMAGES

Cryosurgery as adjuvant therapy in cutaneous sporotrichosis

Cassio Porto Ferreira^I; Maria Clara Gutierrez Galhardo^II; Antônio Carlos Francescone do Valle^III

^IMSc, Techonologist; Dermatologist, Laboratory of Clinical Research in Infectious Dermatology (IPEC/FIOCRUZ)

^IIPost-Doctorate; Researcher, Laboratory of Clinical Research in Infectious Dermatology (IPEC/FIOCRUZ)

^IIIPhD; Researcher, Laboratory of Clinical Research in Infectious Dermatology (IPEC/FIOCRUZ)

^{Correspondence to}

Sporotrichosis is a subacute or chronic disease that affects animals and humans caused by the dimorphic fungus Sporothrix schenkii.¹ An epidemic of sporotrichosis has been noticed in the city of Rio de Janeiro from 1998 onwards and having the cat as the main link in the epidemiological chain.² We have missed a large proportion of these patients and adjuvant cryosurgery with liquid nitrogen^3,4 has been performed in patients that persisted with one or two active lesions whereas the other healed after 2-3 months of treatment. This study aims at evaluating the role of adjuvant treatment in these patients. Methods: 9 patients (7 women/2 men, mean age 45.8 years-old) with cutaneous-lymphatic and fixed sporotrichosis were selected (Figures 1 and 2). All patients had isolated Sporothrix schenckii in culture (Figure 3). Results: Patients underwent monthly sessions of cryosurgery with liquid nitrogen with two cycles of 15 seconds and halo of 5 mm (Figures 4 and 5) with an average of 2.2 sessions (range 1-4 sessions). Five patients had exclusive use of itraconazole for a mean period of 28.8 weeks (range 4-56 weeks) and after the introduction of adjuvant therapy were discharged after a mean period of 12 weeks (range 4-36 weeks). The patient who made use of potassium iodide was discharged after two adjuvant therapy sessions, totaling 12 weeks of treatment. The three patients who used itraconazole and terbinafine, itraconazole used primarily by an average of 21.2 weeks and due to lack of response initiated terbinafine, which when combined with adjuvant therapy were discharged after a mean period of 16 weeks (range 4-28 weeks). In conclusion, cryosurgery with liquid nitrogen⁴ used in patients with slower response to systemic antifungal agents in a few sessions reduces treatment time and thus reducing cost and side effects.

Submitted on: 9/29/2010

Approved on: 10/5/2010

We declare no conflict of interest.

• 1. de Lima Barros MB, de Oliveira Schubach A, Galhardo MC et al Sporotrichosis with widespread cutaneous lesions: report of 24 cases related to transmission by domestic cats in Rio de Janeiro, Brazil. Int J Dermatol 2003; 42:677-681.
• 2. Barros MB, Schubach A de O, do Valle AC et al Cat-transmitted sporotrichosis epidemic in Rio de Janeiro, Brazil: description of a series of cases. Clin Infect Dis. 2004; 38:529-35.
• 3. Moraes AM, Velho PENFV, Magalhães RF. Criocirurgia com nitrogênio líquido e as dermatoses infecciosas. An Bras Dermatol. 2008; 83(4):285-98.
• 4. Bargman H. Successful treatment of cutaneous sporotrichosis with liquid nitrogen: report of three cases. Mycoses; 1995; 38:285-7.

Publication Dates

• Publication in this collection
  06 Apr 2011
• Date of issue
  Apr 2011