Local thermotherapy to treat cutaneous sporotricosis
Update on the global accumulated experience
Abstract
Sporotricosis represents the most frequent human deep mycosis in Uruguay, and it is usually treated with oral potassium iodide. However, local hyperthermia is also frequently used successfully according to several international studies.
The present study aims at the following objectives: 1) to go over the first scientific research that proved the effect of environmental temperature on experimental sporotricosis in laboratory animals, and its immediate consequence on the successful application of local thermotherapy in a human case in Uruguay, back in 1962; 2)to review literature on subsequent clinical trials on local thermotherapy to treat human sporotricosis in other countries and the results obtained in the application of different therapeutic designs; 3) to analyse the main biological mechanisms of action for local thermotherapy in the process of healing lesions according to the results obtained in multiple research studies.
The main conclusion is the current universal acceptance of the effectiveness and harmlessness of local thermotherapy on the disease, whose main indications are iodine intolerance and special physiological situations, such as pregnancy, when they are contraindicated. Local heat is advisable as a complementary treatment to iodine when well tolerated or to itraconazole, with the purpose of shortening the period needed for curing.
According to research conducted by different authors until today, local heat therapy to cure sporotricosis would result from several biological mechanisms. Among them, the direct inhibition of Sporothrix schenckii parasite cells in tissues, localized Hyperleukocytosis, a greater and non-specific action of phagocytosis and other host defense mechanisms; last, a greater efficiency in intra-lekocyte death of parasites through an improved use of I stemming form the MPO- H2O2- I system.
References
(2) Rippon JW. Tratado de micología médica. México: Interamericana. Mc Graw- Hill, 1990.
(3) Restrepo A, Robledo J, Gómez I, Tabares AM, Gutiérrez R. Itraconazole therapy in lymphangitic and cutaneous sporotrichosis. Arch Dermatol 1986; 122(4): 413-7.
(4) Lavalle P, Suchil P, De Ovando F, Reynoso S. Itraconazole for deep mycoses: preliminary experience in México. Rev Infect Dis 1987; 9(Suppl 1): S64-70.
(5) Conti Díaz IA, Civila E, Gezuele E, Lowinger M, Calegari L, Sanabria D, et al. Treatment of cutaneous sporotrichosis with itraconazole. Mycoses 1992; 35(5-6): 153-6.
(6) Mackinnon JE, Conti Díaz IA. The effect of temperature on sporotrichosis. Sabouraudia 1962; 2: 56-9.
(7) Badgwell Doherty C, Doherty SD, Rosen T. Thermotherapy in dermatologic infections. J Am Acad Dermatol 2010; 62(6): 909-27.
(8) Galiana J, Conti Díaz IA. Healing effects of heat and a rubefacient on nine cases of sporotrichosis. Sabouraudia 1963; 3: 64-71.
(9) Mackinnon JE, Conti Díaz IA, Yarzábal LA. Experimental sporotrichosis, ambient temperature and Amphotericin B. Sabouraudia 1964; 3(3): 192-4.
(10) Mackinnon JE. The effect of temperature on the deep mycoses. In: Wolstenholme GE W & Porter R eds. Systemic mycoses. A Ciba Foundation Symposium. London: J& A Churchill Ltd, 1968: 164-78.
(11) Thomas CC, Pierce HE, Labiner, GW. Sporotrichosis resonding to fever therapy. J Am Med Assoc 1951; 147(14): 1342-3.
(12) Laca E. Esporotricosis ulcerosa de la pierna tratada por el calor. Tórax 1964; 13: 229-31.
(13) Trejos A, Ramírez O. Local heat in the treatment of sporotrichosis. Mycopathol Mycol Appl 1966; 30(1): 47-53.
(14) Watanabe S, Morita NS, Takasu T. Local heat therapy of sporotrichosis. Jap J Clin Dermatol 1971; 25: 1053-9.
(15) Lii SL, Shigemi F, Takeda K. Healing effect of local heat on sporotrichosis and three additional cases of Tokushima residence. Tokushima J Exp Med 1973; 20: 57-67.
(16) Tamachi H, Ozawa A, Matsuo I, Niizuma K, Nakano M, Ohkido M. Eight cases of sporotricosis. Tokai J Exp Clin Med 1980; 5(2): 171-5.
(17) Takahashi S, Masahashi T, Maie O. Lokale thermotherapie bei sporotrichose. Hautarzt 1981; 32(10): 525-8.
(18) Shinogi T, Misago N, Narisawa Y. Cutaneous sporotrichosis with refractory and reinfectious lesions in a healthy female. J Dermatol 2004; 31(6): 492-6.
(19) Hiruma M, Kawada A, Yoshida M, Kouya M. Hyperthermic treatment of chromomycosis with disposable pocket warmers. Mycopathologia 1993; 122(2): 107-14.
(20) Conti Díaz IA, Hiruma M. Hyperthermic treatment of sporotricosis. In: Yamaguchi H, Kobayashi GS, Takahashi H, eds. Recent progress in antifungal chemotherapy. New York: Marcel Dekker, 1991: 167-71.
(21) Sutherland GE, Lauwasser M, NcNeely DJ, Shands JW Jr. Heat treatment for certain chronic granulomatous skin infections. South Med J 1980; 73(12): 1564-5.
(22) Hiruma M, Kawada A, Noguchi H, Ishibashi A, Conti Díaz IA. Hyperthermic treatment of sporotrichosis: experimental use of infrared and far infrared rays. Mycoses 1992; 35(11-12): 293-9.
(23) Roberts SOB. Treatment of superficial and subcutaneous mycoses. In: Speller DC E, ed. Antifungal chemotherapy. Toronto: John Willey & Sons, 1980: 225-83.
(24) Romig DA, Voth DW, Liu C. Facial sporotrichosis during pregnancy. Arch Intern Med 1972; 130(6): 910-12.
(25) Bonifaz A, Saúl A, Paredes-Solís V, Fierro L, Rosales A, Palacios A, et al. Sporotrichosis in chilhood: clinical and therapeutical experience in 25 patients. Pediatr Dermatol 2007; 24(4): 369-72.
(26) Hiruma M, Kagawa S. The effects of heat on Sporothrix schenckii in vitro and in vivo. Mycopathologia 1983; 84(1): 21-30.
(27) Hiruma M, Kagawa S. Effects of hyperthermia on phagocytosis and intracellular killing of Sporothrix schenckii by polymorphonuclear leucocytes. Mycopathologia 1986; 95(2): 93-100.
(28) Houssay BA, Lewis JT, Orías O, Menéndez EB, Hug E, Foglia V, et al. Fisiología humana. Buenos Aires: El Ateneo, 1952.
(29) Cunningham KM, Bulmer GS, Rhoades ER. Phagocytosis and intracellular fate of Sporothrix schenckii. J Infect Dis 1979; 140(5): 815-7.
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