Lobomycosis Treatment & Management

Updated: Mar 07, 2022
  • Author: Manuel Valdebran, MD; Chief Editor: Dirk M Elston, MD  more...
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Treatment

Medical Care

To date, there have not been any investigations using pharmacological regimens; however, reports have described efficacy for certain regimens in nonsurgical candidates.

A case report described a therapeutic response to 1-year treatment with a combination of clofazimine at 100 mg/d and itraconazole at 100 mg/d. [14] Clofazimine alone improved the lesions in a few patients. Another case report described a patient in Peru who was cured after 27 months of posaconazole with no recurrence after 5 years of follow-up. An additional case report of an adult male with active lobomycosis on the left earlobe and left posterior helix noted complete resolution clinically and on histology after treatment with surgical excision and 2 years of itraconazole 200 mg/d, clofazimine 100 mg/d, and cryotherapy every 3 months. [83]

Combination itraconazole and clofazimine has been used in the treatment of lobomycosis on the face, with no relapse after 3-year follow up. [84]

Lobomycosis did not respond to treatment with N-methyl glucamine in 3 young adult patients. [53]

Patients with lobomycosis and concurrent leprosy respond to multibacillary therapy, with reduction of pruritus and the size of mycotic nodules. [15]  In a randomized, placebo-controlled, but unblinded study of 103 patients with lobomycosis but without leprosy, multidrug therapy for multibacillary leprosy as outlined by the World Health Organization resulted in a cure rate of 25%. This therapy consisted of clofazimine 50 mg/d and dapsone 100 mg/d, in addition to single monthly doses of clofazimine 300 mg, rifampicin 600 mg, and dapsone 100 mg. [16]

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Surgical Care

The treatment of choice for patients with a localized, surgically amenable form of the disease is surgical excision. [85, 86] Recurrence at the excision site is not uncommon; however, if the disease is detected early, surgical excision may be curative. [80, 85] The major indication for excision is the prevention or correction of disfigurement.

In order to prevent recurrence, itraconazole with cryosurgery has been used successfully to treat relapsing cases. [87]

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