Practical Management of Deep Cutaneous Fungal Infections

Understanding deep cutaneous fungal infection requires not only reading many case reports and checking the typical clinical images of skin lesions, but also managing the patients properly to prevent misdiagnosis. Herein, I review my recent experiences with eight typical cases of deep cutaneous infections (including protothecosis and nocardiosis) in Japan. It is very important to do the four management processes; namely, KOH direct microscopic examination, skin biopsy, fungal culture, and microscopic examination of the histopathological specimen of PAS and Grocott staining. Also, to aid in memorizing the names of important diseases, I recommend the mnemonic "AC PPPS MD" (Aspergillosis, Cryptococcosis, Phaeohyphomycosis, Protothecosis, Pseudoallescheriosis, Sporotrichosis, Mycetoma, and Dermatophytosis). Isolation of the fungus by culturing from the skin lesion is the best way to carry out quick and correct diagnosis.