Primary Cutaneous Cryptococcosis in Immunocompetent Patients: Recognition and Management

Primary cutaneous cryptococcosis (PCC) is a rare, localized fungal infection caused by Cryptococcus species, typically following direct inoculation of the yeast into the skin in immunocompetent individuals. Unlike disseminated cryptococcosis, which is more common in immunocompromised hosts, PCC remains confined to the skin and often arises after minor trauma or environmental exposure. Although traditionally associated with Cryptococcus neoformans (C. neoformans), Cryptococcus gattii (C. gattii) is also increasingly recognized in immunocompetent hosts. Dermatologists are crucial in the early identification of PCC, as its clinical presentation can resemble other dermatologic conditions such as bacterial cellulitis, pyoderma gangrenosum, or atypical mycobacterial infections. This review provides a comprehensive overview of the epidemiology, clinical features, diagnostic methods, and management strategies for PCC. It emphasizes the importance of differentiating PCC from disseminated cryptococcosis and other mimicking conditions. Treatment with oral azoles, such as fluconazole, is typically effective, with a favorable prognosis for most immunocompetent patients. The review also includes practical diagnostic algorithms to assist clinicians in the accurate and timely management of PCC, ultimately improving patient outcomes and reducing unnecessary interventions.