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 Trichophyton rubrum. Other less common culprit dermatophytes include Trichophyton verrucosum, Trichophyton mentagrophytes, and 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 infections and immunosuppressed states can also predispose to its development.

This condition is most common in adults between 20 and 35 years old, with a predilection for females. Majocchi granuloma is more common in females who frequently shave their legs and in those with tinea pedis or onychomycosis.

Immunocompromised patient considerations:
In transplant patients and immunocompromised patients, there is a potential for systemic dissemination. Human immunodeficiency virus (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 dermatophytosis, 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.