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ALA-PDT successfully treated Majocchi's granuloma by directly killing Trichophyton tonsurans and recruiting T
Lei Shi1, Qianqian Wu1, Jin Yang1
1Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Baode Road 1278, Shanghai, 200443, China.
Background:
Majocchi's granuloma (MG) is a deep persistent suppurative granulomatous perifolliculitis which might be caused by Trichophyton tonsurans (T. tonsurans). Conventional treatment for MG is oral administration of systematic antifungal drugs, associated with a low cure rate and a high relapse rate. ALA-PDT is a new approach for fungal infection.
Methods:
A case of refractory MG was treated by 3 times of ALA-PDT. At the same time, T. tonsurans strains isolated from the lesions of the patient were used for an in vitro inhibition experiment and an in vivo experiment in guinea pig model to furtherly verify the effectiveness and investigate the mechanism of ALA-PDT for T. tonsurans.
Results:
After 3 times of ALA-PDT, the lesions of MG were eliminated. And the mycological and pathological examination showed a disappearance of fungi in follicles. In vitro and in vivo experiment both demonstrated that ALA-PDT could obviously inhibit the growth of T. tonsurans partly by directly destroying the structure of fungal cells and recruiting CD4 + T cells.
Conclusion:
ALA-PDT is a potentially effective noninvasive method for the treatment of MG with mechanisms of direct killing and with CD4+ T cell-mediated immune response.
Insights
Majocchi's granuloma (MG) treatment using aminolevulinic acid photodynamic therapy (ALA-PDT) shows promising results. This new approach effectively cleared infections and demonstrated potential for treating deep fungal perifolliculitis.
Area of Science:
- Dermatology
- Mycology
- Photomedicine
Background:
- Majocchi's granuloma (MG) is a deep fungal perifolliculitis often caused by Trichophyton tonsurans.
- Conventional oral antifungal treatments for MG have limited efficacy and high recurrence rates.
- Aminolevulinic acid photodynamic therapy (ALA-PDT) presents a novel therapeutic strategy for fungal infections.
Observation:
- A case of refractory MG was treated with three sessions of ALA-PDT.
- In vitro and in vivo studies investigated ALA-PDT's efficacy and mechanism against T. tonsurans.
Findings:
- ALA-PDT successfully eliminated MG lesions, with mycological and pathological examinations confirming fungal clearance.
- Experiments revealed ALA-PDT inhibits T. tonsurans by directly damaging fungal cells.
- ALA-PDT also demonstrated an ability to recruit CD4+ T cells, suggesting an immune-mediated component.
Implications:
- ALA-PDT offers a potentially effective, noninvasive treatment option for Majocchi's granuloma.
- The treatment mechanism involves direct fungal cell destruction and a CD4+ T cell-mediated immune response.
- Further research into ALA-PDT could lead to improved management of refractory deep fungal infections.
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