Antitubercular Agents

Class Summary

The goals of treatment are to shorten the clinical course, prevent complications, and prevent the development of latency and/or subsequent recurrences, These agents have bactericidal and bacteriostatic activity.

Clofazimine (Lamprene)

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This agent is no longer commercially available in the United States; it is only available by obtaining an investigational new drug (IND), see Dosing Considerations. Use 100 mg/day PO.

Class Summary

The mechanism of action of antifungal agents may involve an alteration of RNA and DNA metabolism or an intracellular accumulation of peroxide that is toxic to the fungal cell.

Itraconazole (Onmel, Sporanox, Sporanox Oral Solution)

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Itraconazole has fungistatic activity. It is a synthetic triazole antifungal agent that slows fungal cell growth by inhibiting CYP450-dependent synthesis of ergosterol, a vital component of fungal cell membranes. Use 100 mg/d PO.

Posaconazole (Noxafil)

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Posaconazole is a triazole antifungal agent. It blocks ergosterol synthesis by inhibiting the enzyme lanosterol 14-alpha-demethylase and sterol precursor accumulation. This action results in cell membrane disruption. Use 400 mg PO twice daily.

Lobo J. Um caso de blastomicose produzido por uma especie nova encontrada em Recife. Rev Med Pernambucana. 1931. 1:763-75.
Schaefer AM, Reif JS, Guzmán EA, Bossart GD, Ottuso P, Snyder J, et al. Toward the identification, characterization and experimental culture of Lacazia loboi from Atlantic bottlenose dolphin (Tursiops truncatus). Med Mycol. 2016 Aug 1. 54 (6):659-65. [QxMD MEDLINE Link].
Fialho A. Blastomicose du tipo "Jorge Lobo". O Hospital. 1938. 14:903.
Borelli D. Aspergillus, sorpresas en micopatologia. Dermatol Venez. 1958. 1:286.
Vilela R, Mendoza L, Rosa PS, Belone AF, Madeira S, Opromolla DV, et al. Molecular model for studying the uncultivated fungal pathogen Lacazia loboi. J Clin Microbiol. 2005 Aug. 43(8):3657-61. [QxMD MEDLINE Link].
Ciferri R, Azevedo PC, Campos S. Taxonomy of Jorge Lobo's disease fungus. Inst Micol Univ Recife. 1956. 53:1-21.
Lacaz CS, Baruzzi RG, Rosa MCB. Doenca de Jorge Lobo. San Paulo: Editora da USP-IPSIS Grafica e Editora. 1986.
Taborda PR, Taborda VA, McGinnis MR. Lacazia loboi gen. nov., comb. nov., the etiologic agent of lobomycosis. J Clin Microbiol. 1999 Jun. 37(6):2031-3. [QxMD MEDLINE Link].
Herr RA, Tarcha EJ, Taborda PR, Taylor JW, Ajello L, Mendoza L. Phylogenetic analysis of Lacazia loboi places this previously uncharacterized pathogen within the dimorphic Onygenales. J Clin Microbiol. 2001 Jan. 39(1):309-14. [QxMD MEDLINE Link].
Mendoza L, Ajello L, Taylor JW. The taxonomic status of Lacazia loboi and Rhinosporidium seeberi has been finally resolved with the use of molecular tools. Rev Iberoam Micol. 2001 Sep. 18(3):95-8. [QxMD MEDLINE Link].
Mendoza L, Vilela R, Rosa PS, Fernandes Belone AF. Lacazia loboi and Rhinosporidium seeberi: a genomic perspective. Rev Iberoam Micol. 2005 Dec. 22(4):213-6. [QxMD MEDLINE Link].
Baruzzi RG, Rodrigues DA, Michalany NS, Salomao R. Squamous-cell carcinoma and lobomycosis (Jorge Lobo''s disease). Int J Dermatol. 1989 Apr. 28(3):183-5. [QxMD MEDLINE Link].
Miranda MF, Silva AJ. Vinyl adhesive tape also effective for direct microscopy diagnosis of chromomycosis, lobomycosis, and paracoccidioidomycosis. Diagn Microbiol Infect Dis. 2005 May. 52(1):39-43. [QxMD MEDLINE Link].
Fischer M, Chrusciak Talhari A, Reinel D, Talhari S. [Sucessful treatment with clofazimine and itraconazole in a 46 year old patient after 32 years duration of disease]. Hautarzt. 2002 Oct. 53(10):677-81. [QxMD MEDLINE Link].
Woods WJ, Belone Ade F, Carneiro LB, Rosa PS. Ten years experience with Jorge Lobo's disease in the state of Acre, Amazon region, Brazil. Rev Inst Med Trop Sao Paulo. 2010 Sep-Oct. 52 (5):273-8. [QxMD MEDLINE Link].
Gonçalves FG, Rosa PS, de Farias Fernandes Belone A, et al. Multidrug Therapy for Leprosy Can Cure Patients with Lobomycosis in Acre State, Brazil: A Proof of Therapy Study. Am J Trop Med Hyg. 2020 Nov 16. 104 (2):634-639. [QxMD MEDLINE Link]. [Full Text].
Sampaio MM, Braga-dias L. The armadillo Euphractus sexcinctus as a suitable animal for experimental studies of Jorge Lobo's disease. Rev Inst Med Trop Sao Paulo. 1977 Jul-Aug. 19(4):215-20. [QxMD MEDLINE Link].
Wiersema JP, Niemel PL. Lobo's disease in Surinam patients. Trop Geogr Med. 1965 Jun. 17(2):89-111. [QxMD MEDLINE Link].
Opromolla DV, Nogueira ME. Inoculation of Lacazia loboi into the subcutaneous tissue of the hamster cheek pouch. Rev Inst Med Trop Sao Paulo. 2000 May-Jun. 42(3):119-23. [QxMD MEDLINE Link].
Sampaio MM, Braga Dias L, Scaff L. Bizarre forms of the aetiologic agent in experimental Jorge Lobo's disease in tortoises. Rev Inst Med Trop Sao Paulo. 1971 May-Jun. 13(3):191-3. [QxMD MEDLINE Link].
Madeira S, Opromolla DV, Belone A. Inoculation of BALB/c mice with Lacazia loboi. Rev Inst Med Trop Sao Paulo. 2000 Sep-Oct. 42(5):239-43. [QxMD MEDLINE Link].
Belone AF, Madeira S, Rosa PS, Opromolla DV. Experimental reproduction of the Jorge Lobo's disease in BAlb/c mice inoculated with Lacazia loboi obtained from a previously infected mouse. Mycopathologia. 2002. 155(4):191-4. [QxMD MEDLINE Link].
Madeira S, Fernandes Belone Ade F, Padovani CR, Araujo Omoprolla DV. Comparative experimental infection of Lacazia loboi in BALB/c and B10.A mice. Rev Iberoam Micol. 2003 Jun. 20(2):55-9. [QxMD MEDLINE Link].
Bhawan J, Bain RW, Purtilo DT, et al. Lobomycosis. An electronmicroscopic, histochemical and immunologic study. J Cutan Pathol. 1976. 3(1):5-16. [QxMD MEDLINE Link].
Sesso A, Baruzzi RG. Interaction between macrophage and parasite cells in lobomycosis. The thickened cell wall of Paracoccidioides loboi exhibits apertures to the extracellular milieu. J Submicrosc Cytol Pathol. 1988 Jul. 20(3):537-48. [QxMD MEDLINE Link].
Woodard JC. Electron microscopic study of lobomycosis (Loboa loboi). Lab Invest. 1972 Dec. 27(6):606-12. [QxMD MEDLINE Link].
Landman G, Velludo MA, Lopes JA, Mendes E. Crossed-antigenicity between the etiologic agents of lobomycosis and paraccocidioidomycosis evidenced by an immunoenzymatic method (PAP). Allergol Immunopathol (Madr). 1988 Jul-Aug. 16(4):215-8. [QxMD MEDLINE Link].
Camargo ZP, Baruzzi RG, Maeda SM, Floriano MC. Antigenic relationship between Loboa loboi and Paracoccidioides brasiliensis as shown by serological methods. Med Mycol. 1998 Dec. 36(6):413-7. [QxMD MEDLINE Link].
Haubold EM, Aronson JF, Cowan DF, McGinnis MR, Cooper CR Jr. Isolation of fungal rDNA from bottlenose dolphin skin infected with Loboa loboi. Med Mycol. 1998 Oct. 36(5):263-7. [QxMD MEDLINE Link].
Minakawa T, Ueda K, Tanaka M, Tanaka N, Kuwamura M, Izawa T, et al. Detection of Multiple Budding Yeast Cells and a Partial Sequence of 43-kDa Glycoprotein Coding Gene of Paracoccidioides brasiliensis from a Case of Lacaziosis in a Female Pacific White-Sided Dolphin (Lagenorhynchus obliquidens). Mycopathologia. 2016 Aug. 181 (7-8):523-9. [QxMD MEDLINE Link].
Burns RA, Roy JS, Woods C, Padhye AA, Warnock DW. Report of the first human case of lobomycosis in the United States. J Clin Microbiol. 2000 Mar. 38(3):1283-5. [QxMD MEDLINE Link].
Vilani-Moreno FR, Lauris JR, Opromolla DV. Cytokine quantification in the supernatant of mononuclear cell cultures and in blood serum from patients with Jorge Lobo's disease. Mycopathologia. 2004 Jul. 158(1):17-24. [QxMD MEDLINE Link].
Marcos EV, Souza FC, Torres EA, Lauris JR, Opromolla DV. [Study of the association between human leukocyte antigens and Jorge Lobo's disease]. Rev Soc Bras Med Trop. 2005 Sep-Oct. 38(5):399-401. [QxMD MEDLINE Link].
De Vries GA, Laarman JJ. A case of Lobo's disease in the dolphin Sotalia Guianensis. Aquatic Mammels. 1973. 1:26-33.
Paniz-Mondolfi AE, Sander-Hoffmann L. Lobomycosis in inshore and estuarine dolphins. Emerg Infect Dis. 2009 Apr. 15(4):672-3. [QxMD MEDLINE Link]. [Full Text].
Caldwell DK, Caldwell MC, Woodard JC, Ajello L, Kaplan W, McClure HM. Lobomycosis as a disease of the Atlantic bottle-nosed dolphin (Tursiops truncatus Montagu, 1821). Am J Trop Med Hyg. 1975 Jan. 24(1):105-14. [QxMD MEDLINE Link].
Symmers WS. A possible case of Lobo's disease acquired in Europe from a bottle-nosed dolphin (Tursiops truncatus). Bull Soc Pathol Exot Filiales. 1983 Dec. 76(5 Pt 2):777-84. [QxMD MEDLINE Link].
Reif JS, Mazzoil MS, McCulloch SD, et al. Lobomycosis in Atlantic bottlenose dolphins from the Indian River Lagoon, Florida. J Am Vet Med Assoc. 2006 Jan 1. 228(1):104-8. [QxMD MEDLINE Link].
Norton SA. Dolphin-to-human transmission of lobomycosis?. J Am Acad Dermatol. 2006 Oct. 55(4):723-4. [QxMD MEDLINE Link].
Rotstein DS, Burdett LG, McLellan W, et al. Lobomycosis in offshore bottlenose dolphins (Tursiops truncatus), North Carolina. Emerg Infect Dis. 2009 Apr. 15(4):588-90. [QxMD MEDLINE Link]. [Full Text].
Haubold EM, Cooper CR Jr, Wen JW, McGinnis MR, Cowan DF. Comparative morphology of Lacazia loboi (syn. Loboa loboi) in dolphins and humans. Med Mycol. 2000 Feb. 38(1):9-14. [QxMD MEDLINE Link].
Reif JS, Schaefer AM, Bossart GD. Lobomycosis: risk of zoonotic transmission from dolphins to humans. Vector Borne Zoonotic Dis. 2013 Oct. 13(10):689-93. [QxMD MEDLINE Link]. [Full Text].
Brun AM. Lobomycosis in three Venezuelan patients. Int J Dermatol. 1999 Apr. 38(4):302-5. [QxMD MEDLINE Link].
Borelli D. Lobomycosis experimental. Dermatol Venez. 1962. 3:72-82.
Rosa PS, Soares CT, Belone Ade F, et al. Accidental Jorge Lobo''s disease in a worker dealing with Lacazia loboi infected mice: a case report. J Med Case Reports. 2009 Feb 16. 3:67. [QxMD MEDLINE Link]. [Full Text].
Paniz-Mondolfi A, Talhari C, Sander Hoffmann L, Connor DL, Talhari S, Bermudez-Villapol L, et al. Lobomycosis: an emerging disease in humans and delphinidae. Mycoses. 2012 Jul. 55 (4):298-309. [QxMD MEDLINE Link].
Francesconi VA, Klein AP, Santos AP, Ramasawmy R, Francesconi F. Lobomycosis: epidemiology, clinical presentation, and management options. Ther Clin Risk Manag. 2014 Oct 9. 10:851-60. [QxMD MEDLINE Link].
Azulay RD, Carneiro JA, Da Graca M, Cunha S, Reis LT. Keloidal blastomycosis (Lobo's disease) with lymphatic involvement: a case report. Int J Dermatol. 1976 Jan-Feb. 15(1):40-2. [QxMD MEDLINE Link].
Talhari C, Rabelo R, Nogueira L, Santos M, Chrusciak-Talhari A, Talhari S. Lobomycosis. An Bras Dermatol. 2010 Apr. 85(2):239-40. [QxMD MEDLINE Link].
Baruzzi RG, Castro RM, D'Andretta C Jr, Carvalhal S, Ramos OL, Pontes PL. Occurrence of Lobo's blastomycosis among "Caiabi," Brazilian Indians. Int J Dermatol. 1973 Mar-Apr. 12(2):95-9. [QxMD MEDLINE Link].
Rodríguez-Toro G, Tellez N. Lobomycosis in Colombian Amer Indian patients. Mycopathologia. 1992 Oct. 120(1):5-9. [QxMD MEDLINE Link].
Florian MC, Rodrigues DA, de Mendonça SBM, et al. Epidemiologic and Clinical Progression of Lobomycosis among Kaiabi Indians, Brazil, 1965-2019. Emerg Infect Dis. 2020 May. 26 (5):930-936. [QxMD MEDLINE Link]. [Full Text].
Arenas CM, Rodriguez-Toro G, Ortiz-Florez A, Serrato I. Lobomycosis in Soldiers, Colombia. Emerg Infect Dis. 2019 Apr. 25 (4):654-660. [QxMD MEDLINE Link]. [Full Text].
Elsayed S, Kuhn SM, Barber D, Church DL, Adams S, Kasper R. Human case of lobomycosis. Emerg Infect Dis. 2004 Apr. 10(4):715-8. [QxMD MEDLINE Link].
Al-Daraji WI. Cutaneous lobomycosis: a delayed diagnosis. Am J Dermatopathol. 2008 Dec. 30(6):575-7. [QxMD MEDLINE Link].
Beltrame A, Danesi P, Farina C, Orza P, Perandin F, Zanardello C, et al. Case Report: Molecular Confirmation of Lobomycosis in an Italian Traveler Acquired in the Amazon Region of Venezuela. Am J Trop Med Hyg. 2017 Dec. 97 (6):1757-1760. [QxMD MEDLINE Link]. [Full Text].
Tapia A, Torres-Calcindo A, Arosemena R. Keloidal blastomycosis (Lobo's disease) in Panama. Int J Dermatol. 1978 Sep. 17(7):572-4. [QxMD MEDLINE Link].
Rose P, Hay RJ. Lobomycosis (Lobo's disease): report of a case from Guyana. Am J Trop Med Hyg. 1981 Jul. 30(4):903-4. [QxMD MEDLINE Link].
Pradinaud R. [Between Yucatan, Florida and French Guiana does lobomycosis exist in the Antilles?]. Bull Soc Pathol Exot Filiales. 1984 May-Jun. 77(3):392-400. [QxMD MEDLINE Link].
Romero RO. Enfermedad de Jorge Lobo (blastomicosis queloidiana). Primer caso diagnosticado en el Puru. Arch Per Pat Clin. 1972. 26:63-86.
Zavala-Velasquez J, Perez AR. Enfermedad de Lobo (lobomicosis). Primer caso mexicano. Dermatologia (Mex). 1978. 22:5-12.
Baruzzi RG, Lacaz Cda S, de Souza FA. [Natural history of Jorge Lobo's disease. Occurrence among the Caiabi Indians (Central Brazil)]. Rev Inst Med Trop Sao Paulo. 1979 Nov-Dec. 21(6):303-38. [QxMD MEDLINE Link].
Fuchs J, Milbradt R, Pecher SA. Lobomycosis (keloidal blastomycosis): case reports and overview. Cutis. 1990 Sep. 46(3):227-34. [QxMD MEDLINE Link].
Lima WDC, Gadelha SQ, Souza MLG, Figueiras VV. Lobomycosis: exuberant presentation with malignant transformation. An Bras Dermatol. 2021 Nov-Dec. 96 (6):762-764. [QxMD MEDLINE Link]. [Full Text].
Francesconi VA, Klein AP, Santos AP, Ramasawmy R, Francesconi F. Lobomycosis: epidemiology, clinical presentation, and management options. Ther Clin Risk Manag. 2014. 10:851-60. [QxMD MEDLINE Link].
Machado P de A. Regrassao espontanea de lesoes maculosas na blastomicose de Jorge Lobo. Acta Amaz (Manaus). 1972. 2:47-50.
Nogueira L, Mendes L, Rodrigues CA, Santos M, Talhari S, Talhari C. Lobomycosis and squamous cell carcinoma. An Bras Dermatol. 2013 Mar-Apr. 88(2):293-5. [QxMD MEDLINE Link]. [Full Text].
Rodríguez-Toro G. Lobomycosis. Int J Dermatol. 1993 May. 32(5):324-32. [QxMD MEDLINE Link].
Lawrence DN, Ajello L. Lobomycosis in western Brazil: report of a clinical trial with ketoconazole. Am J Trop Med Hyg. 1986 Jan. 35(1):162-6. [QxMD MEDLINE Link].
Opromolla DV, Belone AF, Taborda PR, Rosa PS. Lymph node involvement in Jorge Lobo's disease: report of two cases. Int J Dermatol. 2003 Dec. 42(12):938-41. [QxMD MEDLINE Link].
Pang KR, Wu JJ, Huang DB, Tyring SK. Subcutaneous fungal infections. Dermatol Ther. 2004. 17(6):523-31. [QxMD MEDLINE Link].
Baruzzi RG, Marcopito LF, Vicente LS, Michalany NS. Jorge Lobo's disease (keloidal blastomycosis) and tinea imbricata in Indians from the Xingu National Park, Central Brazil. Trop Doct. 1982 Jan. 12(1):13-5. [QxMD MEDLINE Link].
Pecher SA, Fuchs J. Cellular immunity in lobomycosis (keloidal blastomycosis). Allergol Immunopathol (Madr). 1988 Nov-Dec. 16(6):413-5. [QxMD MEDLINE Link].
Vilani-Moreno FR, Belone AF, Soares CT, Opromolla DV. Immunohistochemical characterization of the cellular infiltrate in Jorge Lobo's disease. Rev Iberoam Micol. 2005 Mar. 22(1):44-9. [QxMD MEDLINE Link].
Xavier MB, Ferreira MM, Quaresma JA, de Brito A. HIV and lacaziosis, Brazil. Emerg Infect Dis. 2006 Mar. 12(3):526-7. [QxMD MEDLINE Link].
Talhari C, Chrusciak-Talhari A, de Souza JV, Araujo JR, Talhari S. Exfoliative cytology as a rapid diagnostic tool for lobomycosis. Mycoses. 2009 Mar. 52(2):187-9. [QxMD MEDLINE Link].
Sarmiento-Lacera L, Torres-Fernández O, Rivera JA, et al. Comparative effect of osmium tetroxide and ruthenium tetroxide on Lacazia loboi ultrastructure. Microsc Res Tech. 2021 Apr. 84 (4):789-795. [QxMD MEDLINE Link].
Vilani-Moreno FR, Belone Ade F, Rosa PS, Madeira S, Opromolla DV. Evaluation of the vital staining method for Lacazia loboi through the experimental inoculation of BALB/c mice. Med Mycol. 2003 Jun. 41(3):211-6. [QxMD MEDLINE Link].
Quaresma JA, Unger D, Pagliari C, Sotto MN, Duarte MI, de Brito AC. Immunohistochemical study of Langerhans cells in cutaneous lesions of the Jorge Lobo's disease. Acta Trop. 2010 Apr. 114(1):59-62. [QxMD MEDLINE Link].
Jaramillo D, Cortes A, Restrepo A, Builes M, Robledo M. Lobomycosis. Report of the eighth Colombian case and review of the literature. J Cutan Pathol. 1976. 3(4):180-9. [QxMD MEDLINE Link].
Rodríguez G, Sarmiento L. The asteroid bodies of sporotrichosis. Am J Dermatopathol. 1998 Jun. 20(3):246-9. [QxMD MEDLINE Link].
Rodriguez G, Barrera GP. The asteroid body of lobomycosis. Mycopathologia. 1996-1997. 136(2):71-4. [QxMD MEDLINE Link].
Araújo MG, Cirilo NS, Santos SNMBD, et al. Lobomycosis: a therapeutic challenge. An Bras Dermatol. 2018 Mar. 93 (2):279-281. [QxMD MEDLINE Link]. [Full Text].
Fischer M, Chrusciak Talhari A, Reinel D, Talhari S. [Sucessful treatment with clofazimine and itraconazole in a 46 year old patient after 32 years duration of disease]. Hautarzt. 2002 Oct. 53 (10):677-81. [QxMD MEDLINE Link].
Baruzzi RG, Marcopito LF, Michalany NS, Livianu J, Pinto NR. Early diagnosis and prompt treatment by surgery in Jorge Lobo's disease (keloidal blastomycosis). Mycopathologia. 1981 Apr 10. 74(1):51-4. [QxMD MEDLINE Link].
Azevedo Mde C, Rosa PS, Soares CT, Fachin LR, Baptista IM, Woods WJ, et al. Analysis of Immune Response Markers in Jorge Lobo's Disease Lesions Suggests the Occurrence of Mixed T Helper Responses with the Dominance of Regulatory T Cell Activity. PLoS One. 2015. 10 (12):e0145814. [QxMD MEDLINE Link].
Carneiro FP, Maia LB, Moraes MA, de Magalhães AV, Vianna LM, Zancanaro PC, et al. Lobomycosis: diagnosis and management of relapsed and multifocal lesions. Diagn Microbiol Infect Dis. 2009 Sep. 65 (1):62-4. [QxMD MEDLINE Link].
Bustamante B, Seas C, Salomon M, Bravo F. Lobomycosis successfully treated with posaconazole. Am J Trop Med Hyg. 2013 Jun. 88(6):1207-8. [QxMD MEDLINE Link]. [Full Text].

Media Gallery

Keloidal nodule on the leg. Courtesy of Dr Roberto Baruzzi, Sao Paulo, Brazil.
Lobomycosis in this patient appears as a flat plaque lesion. Courtesy of Dr Roberto Baruzzi, Sao Paulo, Brazil.
Separate keloidal lesions in a localized area. Courtesy of Dr Roberto Baruzzi, Sao Paulo, Brazil.
Characteristic histologic appearance of the organism. Courtesy of Dr Roberto Baruzzi, Sao Paulo, Brazil.

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Author

Manuel Valdebran, MD Junior Specialist Physician, Visiting Scholar in Dermatology/Dermatopathology, Department of Dermatology, University of California, Irvine, School of Medicine

Manuel Valdebran, MD is a member of the following medical societies: International Dermoscopy Society, Medical Dermatology Society, Society for Pediatric Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

Disclosure: Nothing to disclose.

Jeffrey P Callen, MD Professor of Medicine (Dermatology), Chief, Division of Dermatology, University of Louisville School of Medicine

Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, American College of Rheumatology

Disclosure: Received income in an amount equal to or greater than $250 from: Genentech as a consultant for a potential study on a drug that has yet to be approved for any use<br/>Received honoraria from UpToDate for author/editor; Received royalty from Elsevier for book author/editor; Received dividends from trust accounts, but I do not control these accounts, and have directed our managers to divest pharmaceutical stocks as is fiscally prudent from Stock holdings in various trust accounts include some pharmaceutical companies and device makers for these trust accounts; I served on a safety monitoring committee for Principia Biopharma (ended 9-2021) for: Stocks held in various trust accounts: Allergen; Pfizer; 3M; Johnson and Johnson; Merck; Abbott Laboratories; AbbVie; Procter and Gamble; Amgen; Gilead.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Gregory J Raugi, MD, PhD Professor, Department of Internal Medicine, Division of Dermatology, University of Washington at Seattle School of Medicine; Chief, Dermatology Section, Primary and Specialty Care Service, Veterans Administration Medical Center of Seattle

Gregory J Raugi, MD, PhD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Kyle L Horner, MD, MS Physician, Grace Dermatology and Micrographic Surgery, Lebanon, OR

Kyle L Horner, MD, MS is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Dr. Kord Honda, MD, to the development and writing of this article.