Deep Dermal Dilemma: A Case Report on Majocchi's Granuloma After Topical Steroid Use

Majocchi's granuloma represents a unique dermatological entity characterized by the invasion of dermatophytes into the dermis and subcutaneous tissue, typically following trauma or topical corticosteroids, most commonly caused by Trichophyton rubrum. The unrestrained use of over-the-counter topical steroids has led to the rise of Majocchi's granuloma in the past few years. A 57-year-old male presented with complaints of itchy skin lesions over his right ankle for 20 days. There was a history of over-the-counter topical steroid application, following which the lesions exacerbated. Clinical examination showed multiple ill-defined erythematous nodules, 2-3 cm in size, with serosanguinous discharge associated with right ankle swelling. A single annular hyperpigmented scaly patch was also noted over the right leg below the knee. Potassium hydroxide (KOH) examination was positive for fungal hyphae. Histopathological examination (HPE) of the nodule showed features suggestive of Majocchi's granuloma. Fungal culture was performed, which showed growth of Trichophyton rubrum. The patient was started on oral terbinafine 250 mg once daily and topical luliconazole cream twice daily topical application, which resolved the lesions in three weeks, but the patient was advised to continue the treatment for a total duration of two months.