Majocchi granuloma (also known as nodular granulomatous perifolliculitis) is a perifollicular inflammatory reaction caused by infection of hair follicles with fungal species, most commonly dermatophytes. When hyphae invade a hair follicle, a granulomatous and/or suppurative reaction occurs in the dermis and/or subcutaneous tissue. Majocchi granuloma is caused by dermatophytes in over 95% of cases, most commonly caused by Trichophyton rubrum. Other less common culprit dermatophytes include Trichophyton verrucosum, Trichophyton mentagrophytes, or Microsporum canis. The remaining cases may be due to nondermatophytes, including Aspergillus spp.

Majocchi granuloma can occur following trauma to the skin or from occlusion of hair follicles, such as from shaving the legs or face. Involvement of the buttocks and genital skin has been reported. The use of topical steroids on unsuspected tinea and immunosuppressed states can predispose to its development. In children, infection could occur through animal contact.

While Majocchi granuloma is most common in young adults, it can be seen in children as well. It is also common in females who frequently shave their legs and in those with tinea pedis or onychomycosis.

Immunocompromised patient considerations:
HIV-infected individuals with tinea pedis may have a higher risk of progression to Majocchi granuloma on the feet and lower legs.

Majocchi-like granulomas, deep ulcerated fungal infections, severe tinea capitis and corporis, and fungal nail involvement are characteristic of an inherited deficiency of CARD9 (caspase recruitment domain-containing protein 9), an inflammatory cascade-associated protein.