Skin lesion of Coccidioidomycosis

Causes and Risks:
A coccidioidomycosis infection is caused by inhaling the spores of a mold-like fungus (Coccidioides immitis) that is found in the soil of hot, dry regions. About 60% of the infections cause no symptoms and are only recognized by a positive coccidioidin skin test . In the remaining 40%, symptoms primarily involve the lung (pulmonary) and nonspecific general symptoms. These may range from mild cold or flu-like symptoms to severe illness. Darker skinned people generally have more severe symptoms. Immunocompromised individuals such as those with AIDS may experience disseminated coccidioidomycosis which includes skin lesions .

Incubation is 10 to 30 days. Nonspecific skin rashes , a scarlet fever-like rash or erythema nodosum , often develops within a week of onset of other symptoms. This rash is not significant and may actually indicate a healthy immune response . The severe form of cutaneous coccidioidomycosis develops later, after an initial infection has become chronic or disseminated. This rash begins as red papules , often on the face scalp and neck. These papules may develop into ulcers and finally into highly vascular warty lumps ( granulomas ). Abscesses may also form. The skin lesion often resembles those of other fungal skin infections such as blastomycosis and histoplasmosis .

Prevention:
None known. Prompt treatment of the initial Coccidioidomycosis infection may help prevent development of skin lesions .

Symptoms:



Signs and Tests:
The diagnosis is based on the appearance of the skin lesion and a history of living in or visiting an endemic area, or known Coccidioidomycosis infection.

Coccidioidomycosis infection may be confirmed by:

A biopsy of skin lesion may show infection with Coccidioides immitis.

Treatment:
The treatment includes medication to decrease the infection and symptomatic treatment of skin lesions .

Medications include antifungals such as:

  • amphotericin B
  • ketoconazole
  • fluconazole
  • itraconazol

Treatment may be prolonged over weeks to years to control a persistent or chronic infection.

The symptomatic treatment of skin lesions may include surgical drainage of abscesses and topical (applied to a localized area of the skin) antifungal medications.

Prognosis:
The outcome varies with the extent of infection. If the Coccidioidomycosis can be controlled, the skin lesions may improve. The disseminated disease has a significant death rate. The course may be rapid for immunosuppressed patients.

Complications:



Call Your Healthcare Provider:
Call for an appointment with your health care provider if you think you may have the skin lesion of Coccidioidomycosis.

Call for an appointment with your health care provider you have coccidioidomycosis and new symptoms develop, especially cough , fever , chills, headache, muscle stiffness and aching, neck or shoulder stiffness, change in mental status, or sensitivity to light; or skin lesions develop pain, redness, swelling, drainage.


Erythema nodosum usually occurs in association with specific infections, inflammatory conditions, or medications. It consists of painful, hot, red skin lumps, usually over the shins. People with erythema nodosum should be evaluated for other disease processes.



Coccidioidomycosis is most commonly a lung infection, but it can also infect the skin. Cutaneous coccidioidomycosis on the forehead is pictured here. This occurs more frequently in warmer climates, including California and the Southwestern United States.



This person has erythema nodosum nodules on the feet. The feet are red and painful. This disorder is associated with rheumatic disease, but may also be caused by drugs or infections.