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Key Features

  • A chronic, principally tropical cutaneous infection

  • Usually affects older men who are agricultural workers

  • Caused by several species of closely related black molds

  • Fonsecaea pedrosoi and Cladiophialophora carrionii are most common etiologic pathogens

Clinical Findings

  • Lesions usually follow puncture wounds

    • Occur most frequently on lower extremity

    • Begin as a papule or ulcer

  • Over months to years, papules enlarge to become vegetating, papillomatous, verrucous, elevated nodules along with scarring

  • Secondary bacterial infection may occur

  • Elephantiasis as well as squamous cell cancers may result

Diagnosis

  • Potassium hydroxide preparations of pus or skin scrapings are helpful, showing brown, thick-walled, spherical, sometimes septate cells

Treatment

  • Itraconazole, 200–400 mg orally once daily for 6–18 mo, achieves response rate of 65%

  • Terbinafine (500–1000 mg/day orally) may be equivalent to itraconazole

  • Photodynamic therapy combined with antifungal drugs has been used successfully

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