From the Guidelines
Valley fever rash is typically managed with antifungal medications such as fluconazole (400-800 mg daily) for 3-6 months in symptomatic cases, and the rash itself may be managed with antihistamines for itching or anti-inflammatory medications for discomfort. The rash associated with Valley fever usually appears as red bumps, nodules, or painful red lumps called erythema nodosum, usually on the lower legs 1. Some patients may develop a more widespread rash that can be flat or raised, sometimes with blisters. If you develop a rash along with fever, cough, fatigue, headache, or joint pain, especially after being in an endemic area like Arizona or California, seek medical attention promptly.
Treatment Considerations
- The recommended dose of fluconazole is 400 mg daily, although some panel members would use up to 800 mg daily 1.
- The recommended dose of itraconazole is 200 mg twice daily 1.
- Treatment duration is typically at least 6-12 months due to high relapse rates 1.
- For patients with concurrent diabetes or who are otherwise frail because of age or comorbidities, initiating antifungal treatment is recommended 1.
Disease Overview
Valley fever is caused by inhaling spores of the fungus Coccidioides, which primarily affects the lungs but can disseminate to the skin and other organs in some cases. The rash represents the body's immune response to the fungal infection and typically improves as the underlying infection is treated. Soft tissue coccidioidomycosis can be divided into skin lesions, subcutaneous abscesses, and distant soft tissue sites, with cutaneous granulomatous lesions being the most benign form of coccidioidal dissemination 1.
Management Approach
In general, oral azoles have become the treatment of choice due to lower toxicity and convenience of administration 1. Prospective trials of azole therapy for skin and soft tissue coccidioidomycosis report response rates ranging from 25% to 91%, with relapse rates ranging from 60% after 45 days of therapy, to 11% after 12 months 1. For most patients, treatment with antifungal medications and management of symptoms is the primary approach to managing Valley fever rash.
From the Research
Valley Fever Rash
- Valley fever, also known as coccidioidomycosis, is a fungal infection caused by the inhalation of Coccidioides endospores 2.
- The symptoms of coccidioidomycosis include fever, erythema nodosum, and arthralgia, often accompanied by a respiratory problem 2.
- A rash can be a symptom of Valley fever, with erythema nodosum being a common manifestation 2, 3.
- The diagnosis of coccidioidomycosis is typically made through a combination of clinical evaluation, antibody tests, and microscopy to directly detect the presence of Coccidioides in a patient tissue sample 2.
- Treatment for Valley fever typically involves symptomatic treatment, with antifungal medications such as azoles or amphotericin B used in more severe cases 2, 3, 4, 5.
Treatment Considerations
- The treatment of coccidioidomycosis varies depending on the immunocompetency of the patient, with pregnant patients and those with a history of HIV or transplantation requiring special considerations 2, 3, 5.
- Fluconazole is a commonly used antifungal medication for the treatment of pulmonary coccidioidomycosis 2, 3, 5.
- Other antifungal medications, such as voriconazole and posaconazole, may be used as salvage treatment for refractory coccidioidomycosis 4.
- The treatment of fungal pneumonias, including coccidioidomycosis, is a major concern in immunocompromised patients, and clinicians should consider the most appropriate and aggressive treatment approach 6.