Cervicofacial actinomycosis: a report of 14 patients observed at the Dermatology Unit of the University of Milan, Italy

Background: Actinomycoses are rare chronic infections often caused by Actinomyces spp. Cervicofacial actinomycosis (CFA) is caused by primary lesions in the oral cavity and subsequent fistulae, and suppurative and granulomatous lesions on the skin of the face. Methods: We present the results of a retrospective study on 14 patients with CFA, observed in the period 1984–2019 at the Dermatology Unit of the University of Milan. Physical general and dermatologic examinations, instrumental tests, and histopathologic and bacteriologic examinations were carried out in all patients. In three patients, polymerase chain reaction was also carried out. Results: Six patients showed poor oral hygiene; eight patients had been subjected to previous surgical operations in the oral cavity. Histopathologic examination was superimposable in all patients. In four patients, bacteriologic examinations were positive for A. israelii. In three patients, polymerase chain reaction was positive for A. israelii. X-rays of the bones of the face showed osteolytic lesions in four patients. All patients were successfully treated with benzathine benzylpenicillin followed by amoxicillin or with amoxicillin in monotherapy. In all patients, surgical drainage and debridement of the oral cavity were carried out. Conclusion: CFA is a rare infection caused by primary lesions in the oral cavity and subsequent fistulae, and nodular and ulcerative lesions on the skin of the face. Clinical diagnosis must be confirmed by histopathologic, bacteriologic, and instrumental examinations. Therapy with penicillins is usually very long and must be accompanied by surgical drainage and debridement of the oral cavity.