Key points for systemic mycoses

• Systemic mycoses are not usually treated primarily by dermatologists.

• Most opportunistic mycoses are seen in immunocompromised patients.

• Skin lesions in most endemic mycoses such as paracoccidioidomycosis probably result from lung dissemination.

• They occasionally exhibit direct skin invasion following infiltration of organisms or indirect skin manifestations such as erythema nodosum or multiforme, probably from immune complex deposition.

• Although many patients with cutaneous cryptococcal infection probably develop skin involvement as a result from internal spread, some cases of primary cutaneous cryptococcus do exist.

• Anecdotal evidence suggests that itraconazole or fluconazole might be effective in such cases.

• A number of controlled clinical trials for the treatment of systemic mycoses are currently underway by the US Mycosis Study Group and the EORTC.

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