GD05: Clinical interventions for cutaneous sporotrichosis

Emily Welch¹ and Janice Yeon²

¹Surrey and Sussex NHS Trust, Redhill, UK; and ²The Skin Hospital, Sydney, Australia

This systematic review aimed to synthesize evidence on the effectiveness of treatment options for cutaneous and lymphocutaneous sporotrichosis. Sporotrichosis is a chronic mycotic infection caused by the dimorphic fungus Sporothrix schenckii complex and other Sporothrix species. Sporotrichosis can develop up to 12 weeks after exposure to the fungus. Patients commonly present with painless erythematous ulcerating nodules that spread along the lymphatic vessels. These lesions commonly occur on the face in children and affect the upper limbs in adults. Sporotrichosis is mainly considered to affect men due to outdoor work and contact with infected soil or moss. However, infection has recently been linked to zoonotic spread from infected cats, which has led to an endemic in Brazil. Sporotrichosis has been treated with potassium iodide for over 100 years. More recently, sporotrichosis has been treated with itraconazole and terbinafine, as per the Infectious Diseases of America Guidelines. Despite this, the efficacy and adverse reactions of these treatments have not been systematically reviewed. Two authors independently assessed trial quality and analysed randomized and nonrandomized studies investigating the treatment options for cutaneous and lymphocutaneous sporotrichosis. Searches produced a low yield of results, with only nine full studies being included. The studies represented 1335 participants over a 22-year period from 1996 to 2018. The studies showed heterogeneity, with little evidence per treatment option, making treatment recommendations difficult. All included studies were graded as having a low or a very low quality of evidence. The evidence for the treatment of sporotrichosis is not reliable and we are unable to recommend confidently treatment options. The use of phylogenetics in future studies could be beneficial, as different Sporothrix species may respond uniquely to treatments and doses. Sporotrichosis is an endemic disease in low socioeconomic areas in tropical climates. Therefore, sporotrichosis should be considered as a neglected tropical disease (NTD). Recognition as an NTD may lead to prioritization for well-designed, reliable studies in the future. International multicentre studies are needed in the form of randomized controlled trials.