Treatment options
1.Internal medicine
(1) Iodide: 5-10% potassium iodide 3g/d, can be gradually increased to 6-8g/d, the damage disappeared can be followed by 2-4 weeks, the general course of treatment 2-3 months. Potassium iodide saturated solution 10 drops / time, 3 times / d, can be gradually increased to 40 drops, 3 times / d, generally 1 week to see the effect, 1 to 2 months can be cured. If there is indigestion or gastrointestinal reaction such as nausea, vomiting and poor appetite when taking potassium iodide orally, sodium iodide 1g/d can be pushed intravenously. If the patient has pulmonary tuberculosis, potassium iodide should not be applied.
(2) Ashwagandha: It is less effective and is generally not used. It can be considered for those who are allergic to iodine, 0.8g/d for 1 to 3 months.
(3) Flucytosine: 100~200mg/kg body weight until cured.
(4) Itraconazole.
(i) Lymphatic vascular type: 100～200mg/d for 3～6 months.
(2) Fixed type: 50～100mg/d for 3～6 months.
(5) Terbinafine: 2 times/d, 0.25g each time, usually taken for 1~2 months.
(6) Fluconazole: 200～400mg/d.
(7) Amphotericin B can be applied to cutaneous lymphovascular type and disseminated sporotrichosis. The first dose is 3~5mg, adults can increase to 30~35mg for 1~2 months.
2.Topical medication
2% potassium iodide or 0.2% iodine solution can be used topically; 2% globular erythromycin dimethyl sulfoxide permeation, 2 times/d; amphotericin B 250-500mg, 30ml dimethyl sulfoxide, glycerin 20ml, water 50m1, prepared into a permeation agent for topical use; warming therapy 45℃ electric heater local heating, 3 times/d, 60min each time, effective for isolated damage.
Histopathology
Purulent inflammation formed by histiocyte-dominated granulomas and neutrophil infiltration. PAS staining in abscesses and multinucleated giant cells can sometimes find spores or stellate bodies.
Preventive treatment
1. 10% potassium iodide solution is the drug of choice, 10-20 ml orally 3/day, after meals, and starting with small doses and gradually increasing them. If the patient can tolerate it, treatment should be extended until 4-6 weeks after clinical cure.
2.Itraconazole 100mg orally 1/day for more than one month.
3.Tebiprofen 250mg orally 1/day for 3 months.
4.5-FC orally 1.5~2g/day, can be combined with ketoconazole, 200mg/day for 2~3 months.
5.Dimycin B applicable to the above drug treatment is ineffective, static drip, also can be formulated into a 0.25% solution of local damage intra-injection.
Local damage can be considered excision treatment, or physical therapy, heat therapy or cryotherapy.
Medication principles
1.Surgical excision, radium or cryotherapy can be chosen for smaller lesion limitations.
2. internal systemic antifungal drugs for those with generalized or larger lesions.
3. Potassium iodide is contraindicated in patients with iodine allergy or tuberculosis.
4, 5-Fc is often used in combination with other antifungal drugs to reduce toxic side effects and drug resistance.
5, diphenhydramine B side effects, only used for other antifungal treatment is ineffective.
Systemic treatment can be supplemented with topical topical antifungal preparations, heat therapy or physical therapy.
This is a deep mycosis caused by the sporulating fungus, mainly invades the skin, but occasionally can also invade the mucous membranes, lungs, meninges and other visceral organs. Before the onset of the disease, the skin often has a history of trauma, and then contact with the soil or plants with bacteria, the bacteria from the damaged skin into the body, about 1 to 3 weeks, on the initial invasion of the site to produce boil-like damage, generally not painful, nor fever, ulcers formed after breaking, not much pus; can also be papules, warty damage, plaques, cauliflower-like pseudotumor. The damage may be fixed in one place for a long time or spread upward along the lymphatic vessels, producing a string of similar damages, several to dozens arranged in strips. The upper extremities generally have the greatest chance of developing the disease, followed by the lower extremities, and in recent years the face has become quite common. Very rarely, it can invade the bloodstream and cause widespread dissemination of the skin and internal organs. The diagnosis can be established by squeezing out the pus and blood from the damage for culture, which can often isolate the pathogenic bacteria. Iodide is effective for this disease, and is usually given orally in 10% potassium iodide solution, 10 ml each time, three times a day, for a period of 2 to 3 months. Local warmth therapy can play an auxiliary role. Prevention of skin trauma is important for the prevention of this disease. The dressings changed by the patient should be burned to avoid contaminating the environment and infecting others.