Majocchi’s granuloma caused by Trichophyton rubrum after facial injection with hyaluronic acid:A case report

BACKGROUND Facial cosmetic procedures become popular for people with a desire to have a younger appearance,and cosmetic technology has developed rapidly over the past several decades.However,increasing complications related to cosmetic injections have been reported,and infection is one of the most serious problems and can cause anxiety and facial injury.We here report a case of Majocchi’s granuloma(MG)caused by Trichophyton rubrum after facial injection of hyaluronic acid.CASE SUMMARY A 37-year-old woman presented to our hospital with a history of red papules,nodules,and abscesses on her left zygomatic arch for 2 mo.She had received a cosmetic injection of hyaluronic acid on the left side of her face prior to the appearance of the lesions.MG caused by Trichophyton rubrum after facial injection of hyaluronic acid was diagnosed based on morphology and molecular biological identification.In vitro antifungal susceptibility testing was conducted according to the Clinical and Laboratory Standards Institute M38-A2 method.Minimal inhibitory concentrations were used to evaluate the antifungal susceptibility.The antifungal agents and their minimal inhibitory concentrations for the strain were terbinafine(<0.5μg/mL),itraconazole(0.06μg/mL),amphotericin B(0.25μg/mL),fluconazole(32μg/mL),voriconazole(0.125μg/mL),posaconazole(0.125μg/mL),and isavuconazole(0.06μg/mL).We initially administered 250 mg/d oral terbinafine for 2 mo,but the patient still had painful papules,nodules and abscesses on her face.Then,we adjusted the treatment to itraconazole 400 mg/d for 8 wk based on the in vitro antifungal susceptibility testing results.The skin lesions improved significantly,and there was no recurrence during follow-up.CONCLUSION This case revealed that facial injection of hyaluronic acid may cause serious MG.Antifungal susceptibility testing should be considered in the treatment of MG caused by Trichophyton rubrum.

Therapeutic Efficacy Observation on Mild Lifting and Superficial Pulling Point-towards-point Needling for Intractable Facial Palsy

Objective: To observe and compare the clinical effects of combining mild lifting and superficial pulling point-towards-point needling and point injection and integrated standard electroacupuncture(EA) with intramuscular injection of Mecobalamin for intractable facial palsy. Methods: Eighty cases with intractable facial palsy were randomized into a treatment group and a control group, 40 in each group. Cases in the treatment group were treated with mild lifting and superficial pulling point-towards-point needling Xiaguan(ST 7) coupled with point injection of Mecobalamin. Cases in the control group were treated with standard EA coupled with intramuscular injection of Mecobalamin. After three courses of treatment, the between-group comparisons of Portmann scores and clinical effects were conducted. Results: After three courses of treatment, the Portmann scores in both groups were higher than the scores before treatment(P<0.01); the Portmann score in the treatment group was higher than that in the control group(P<0.05) and the total effective rate in the treatment group was higher than that in the control group(P<0.05). Conclusion: Combining mild lifting and superficial pulling point-towardspoint needling and point injection of Mecobalamin could obtain better effect for intractable facial palsy than standard EA coupled with intramuscular injection of Mecobalamin.