Chris Schach

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Key Points
*Chronic skin infection typically affecting the foot
*Caused by a bacterial or fungal infection
*Presents as a solitary, hard lump, which grows slowly, collapsing in the center and discharging fluid and grains

Mycetoma is a chronic skin infection which typically affects the feet, but may develop in other areas. The condition initially consists of a solitary, hard lump which is painless. The lesion grows slowly, and eventually collapses in the center, becoming ulcerated and discharging fluid and grains. Sinus tracts may then form around the lesion, which also experience the same discharge. The color of grains in discharge is predicated on the species of the infectious organism, and may be black, white, yellow, or red/brown. Lesions may grow to involve deep tissue and even bone, and the skin in the affected area will be pale and scarred. The condition may lead to severe deformity, though it is not often accompanied by other symptoms aside from mild itching or burning. The condition is prone to secondary infection.

Mycetoma is caused by a bacterial or fungal infection, typically at the site of an injury. The condition is much more common in men, and usually appears in persons 20-50 years old.

Differential Diagnosis (Other conditions with similar appearance)Chromoblastomycosis
Mycobacterium infection
Hansen disease
Thorn granuloma
Necrotizing fasciitis
Cold Abscess

    Key Points
    *Diagnosis based on the identification of grains in discharge
    *Skin biopsy may be performed to confirm diagnosis and rule out other conditions

    Mycetoma is diagnosed based on the identification of grains in discharge from the lesion through laboratory testing. A skin biopsy may be performed to confirm the diagnosis and to rule out other, similar appearing conditions.

    *Condition will not clear without treatment
    *Mild or early cases are typically treated with antibiotic medications, singly or in conjunction with others
    *Severe cases require more aggressive treatment

    Mycetoma will not clear without treatment. In cases in the early stages of the condition, treatment typically consists of antibiotic medications, either singly or in conjunction with others. Medications used include streptomycin, cotrimoxasole, amikacin, dapson, rifampicin and minocycline. In severe cases, treatment is by nature more aggressive, and may include administration of Itraconazole or ketoconazole, in addition to surgical excision of affected tissue. This may include removal of bone which has been affected, indicating amputation.

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