Cryosurgery for the treatment of cutaneous sporotrichosis in four pregnant women

Abstract

BackgroundPregnant women with sporotrichosis should not receive systemic antifungal therapy except in severe cases when amphotericin B is recommended. Thermotherapy is the most reported treatment described in this group of patients. It entails weeks of daily self-application of heat to the lesions, requires that the patient faithfully apply it, and it could cause skin burns. Cryosurgery is a useful therapeutic tool for many cutaneous infectious diseases, safe for pregnant women, but not well evaluated for sporotrichosis treatment in this group.MethodologyThe authors conducted a retrospective study describing epidemiological, clinical, and therapeutic data related to four pregnant patients with sporotrichosis treated with cryosurgery. The authors reviewed the clinical records of four pregnant patients diagnosed with cutaneous sporotrichosis and treated with cryosurgery. The sessions were carried out monthly up to clinical cure. Molecular identification of the Sporothrix species was performed in two cases using T3B PCR fingerprinting assays.Principal findingsAll patients were in the second trimester of pregnancy and their age ranged from 18 to 34 years. With regard to clinical presentation, two patients had lymphocutaneous and two had the fixed form. S. brasiliensis was identified in two cases as the causative agent. Cryosurgery was well tolerated and the number of sessions ranged from 1 to 3. All the patients reached a complete clinical cure.ConclusionsCryosurgery was a safe, easy to perform and well tolerated method, and therefore it is suggested to be a suitable option for the treatment of cutaneous sporotrichosis in pregnant women.

A One Health Approach to Combatting Sporothrix brasiliensis: Narrative Review of an Emerging Zoonotic Fungal Pathogen in South America

“…Alternatively, terbinafine at 500 mg twice daily may be used for fixed cutaneous and lymphocutaneous forms if ITZ is contraindicated [ 72 ]. Additionally, cryosurgery and local heat therapy may be used in conjunction with antifungals to reduce therapy duration, for the treatment of pregnant women, or to treat recalcitrant, hyperkeratotic lesions [ 73 , 74 , 75 , 76 , 77 ].…”

Esporotricosis cutánea linfangítica tratada con yoduro de potasio y criocirugía

“…[16][17][18][19] Además de ser un método terapéutico seguro en mujeres embarazadas, con una recomendación de evidencia B-III. 18,20 Esta forma de tratamiento se basa en la destrucción selectiva de células o tejidos a través de un proceso de congelación, llegando de -20 a -30 o C, lo que resultará en una lesión necrótica. Los métodos de aplicación de la criocirugía dependen del tipo, forma, tamaño y ubicación de la lesión.…”

“…Ambas con un intervalo de 4 minutos entre cada ciclo y reaplicando sesiones cada 30 días. [16][17][18][19][20] En nuestro caso, puesto que el paciente presentaba una lesión elevada, cumplió el criterio para aplicar ciclos de 60 segundos de congelación y descongelación cada semana. 21 Ferreira y colaboradores (2010) describen nueve casos con esporotricosis linfocutánea y localizada: un paciente tratado con yoduro de potasio, cinco con itraconazol y tres con terbinafina; además, terapia adyuvante de nitrógeno líquido.…”

“…Todas las pacientes alcanzaron una curación clínica completa y no se observaron reacciones adversas durante el tratamiento ni recaídas. 20 La importancia del presente caso radica, en primer lugar, en la sensibilidad de Sporothrix schenckii a las temperaturas bajas del nitrógeno líquido, que puede ser utilizado de forma sola o adyuvante con antimicóticos sistémicos, en ambas con buena respuesta clínica. 3,[20][21][22] BIBLIOGRAFÍA En segundo lugar, el uso de la dermatoscopia como auxiliar del diagnóstico, ya que en ésta infección de origen micótico ha sido poco utilizada.…”

Nodular Lymphangitis (Sporotrichoid Lymphocutaneous Infections). Clues to Differential Diagnosis

“…Terbinafine is also a potentially effective choice. Local heat applications (thermotherapy) or cryosurgery can accelerate resolution and can be considered as complementary therapies in specific situations, such as pregnancy or where there are potential interactions with other medications [ 22 ]. There are important variations in the results of antifungal susceptibility tests among the main subspecies of the Sporothrix schenckii complex, with Sporothrix brasiliensis being the most sensitive and Sporothrix mexicana the least [ 21 ].…”