Therapeutic Strategies for Lobomycosis (Lacazia loboi): A Systematic Review of Clinical Evidence and Management Outcomes

Introduction:
Lobomycosis (lacaziosis), caused by Lacazia loboi, is a chronic cutaneous–subcutaneous mycosis endemic to the Amazon basin and other tropical regions. Due to an inability to culture the organism in vitro and the rarity of cases, standardized treatment guidelines are lacking. Therapeutic decisions rely primarily on case reports and small case series. This systematic review aims to synthesize available evidence regarding medical and surgical treatment outcomes for lobomycosis.

Methods:
A systematic search of PubMed/MEDLINE, Scopus-indexed sources, and open-access repositories was conducted through February 2026 using the terms “lobomycosis,” “lacaziosis,” “Lacazia loboi,” and “treatment.” Eligible studies included case reports, case series, and narrative reviews reporting therapeutic interventions and clinical outcomes. Extracted variables included type of intervention, antifungal regimen and duration, clinical response, recurrence, and follow-up time. Due to heterogeneity and absence of controlled trials, a qualitative synthesis was performed.

Results:
Evidence is limited to observational data, predominantly individual case reports and small series. Surgical excision remains the most frequently employed treatment for localized disease but is associated with recurrence, particularly in multifocal or extensive lesions. Systemic antifungal therapy with itraconazole has demonstrated variable responses, often requiring prolonged administration. Combination therapy with itraconazole and clofazimine has been associated with clinical remission in selected cases. Posaconazole has shown promising outcomes in refractory or extensive disease, with sustained remission reported after long-term therapy (≥12 months). However, treatment duration, dosing regimens, and follow-up periods vary considerably across reports.

Conclusions:
No standardized or evidence-based therapeutic protocol exists for lobomycosis. Combined surgical and prolonged systemic antifungal therapy appears to offer better outcomes than monotherapy. Posaconazole represents a promising option for extensive disease, although cost and limited evidence remain constraints. Prospective multicenter studies and regional registries are urgently needed to establish optimal management strategies for this neglected tropical disease.