Skin lesion of coccidioidomycosis

Skin lesions of coccidioidomycosis are a manifestation in the skin of a fungal infection caused by Cocciodioides inmitis.

Causes, incidence, and risk factors

Coccidioidomycosis is a fungal infection most often found in the desert regions of the southwestern US and in Central and South America. It is acquired by inhaling fungal particles from soil in these regions. The portal of entry for this infection is the lung.

Up to one-half of affected individuals have mild or no symptoms. Immunosuppressed individuals, such as people with AIDS or cancer or transplant recipients, are at higher risk of severe, widespread (disseminated) disease.

Skin lesions can occur in the early stages of coccidioidomycosis (during primary lung infection). They include erythema nodosum or erythema multiforme. These Rashes usually clear without treatment and are believed to be caused by an immune response to the infection.

After primary infection in the lungs, the fungus itself may spread to other tissues including the skin and lead to various skin lesions including papules, nodules, and ulcers. These lesions contain fungus within them and are a manifestation of disseminated (widespread) fungal disease.


  • Skin lesion of primary infection       o Papular rash       o Erythema nodosum       o Erythema multiforme (target lesions)  
  • Skin lesion of disseminated disease: papule, pustule, nodule, or plaque       o May ulcerate       o Are most frequently found on the face       o May form abscesses

Signs and tests
The diagnosis depends on the stage of infection (primary versus disseminated) and may include skin biopsy to detect the fungus in culture if disseminated disease is suspected.

The mainstay of treatment includes antifungal medications. Depending on the form or stage of disease, intravenous or oral preparations may be used. Antifungal agents commonly used include amphotericin B, itraconazole, ketoconazole, or fluconazole. People with disseminated disease and underlying immunosuppression may require long-term treatment.

Expectations (prognosis)
The outcome varies with the stage and extent of infection, as well as the underlying immune system status of the individual. Disseminated disease has the highest mortality rate, particularly in immunosuppressed individuals.


  • Secondary bacterial skin infection  
  • Skin abscess  
  • Complications related to medications

Calling your health care provider
There are many types of skin lesions, and they can be hard to tell apart. Notify your medical provider if you develop skin lesions and suspect this condition, as you will need to be formally evaluated.

Johns Hopkins patient information

Last revised: December 4, 2012
by Amalia K. Gagarina, M.S., R.D.

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