Chromoblastomycosis

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

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

Lesions may vary in appearance and have been classified into five categories

• Nodular

• Verrucous or warty

• Plaque (infiltrative or erythematous)

• Tumoral

• Atrophic

Secondary bacterial infection may occur

Elephantiasis as well as squamous cell cancers may result

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

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; the two may be useful in combination

5-fluorocytosine in combination with one of the above drugs also has been shown to be active, but adverse events with this drug have to be monitored carefully

Photodynamic therapy combined with antifungal drugs has been used successfully as have immunomodulatory drugs like imiquimod