The large majority of cases reported worldwide as
zygomycosis are
infections caused by fungi belonging to the order Mucorales. These
infections are invasive, often lethal, and they primarily affect immunocompromised patients. Cutaneous
zygomycosis is the third most common clinical presentation, after
sinusitis and
pulmonary disease. Most patients with cutaneous
zygomycosis have underlying diseases, such as
hematological malignancies and
diabetes mellitus, or have received solid
organ transplantation, but a large proportion of these patients are immunocompetent.
Trauma is an important mode of acquiring the disease. The disease can be very invasive locally and penetrate from the cutaneous and subcutaneous tissues into the adjacent fat, muscle, fascia, and bone. The diagnosis of cutaneous
zygomycosis is often difficult because of the nonspecific findings of the
infection. The clinician must have a high degree of suspicion and use all available diagnostic tools, because early diagnosis leads to an improved outcome. The treatment of
zygomycosis is multimodal and consists of surgical
debridement, use of antifungal drugs, and reversal of underlying risk factors, when possible. The main antifungal
drug used in the treatment of
zygomycosis is
amphotericin B.
Posaconazole is sometimes used for
salvage treatment, as continuation of treatment after initial administration of
amphotericin B, or in combination. The mortality of cutaneous
zygomycosis is lower in comparison with other forms of the disease, but it is still significant. When the disease is localized, mortality still ranges from 4% to 10%.