Diagnosis and Treatment of Cutaneous Aspergillosis

Aspergillosis is an opportunistic mycosis caused by fungi in the genus Aspergillus, mostly A. fumigatus and A. flavus. Typical entry portals in primary cutaneous aspergillosis include burns, trauma sites, surgical wounds, intravenous catheters, and macerated skin in underlying occlusive dressings. In individuals who are immunocompromised, the dissemination risk is significant. Skin findings range from firm papules and necrotic papulonodules to hemorrhagic bullae and ulcers. The prognosis is poor but improves when the patient is no longer neutropenic or when corticosteroids are discontinued. Localized primary cutaneous aspergillosis can be excised surgically, followed by oral antifungal administration. For the first-line treatment of pulmonary invasive aspergillosis, isavuconazole and voriconazole are the preferred agents, whereas liposomal amphotericin B is supported moderately.