Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 36-13: Chromoblastomycosis (Chromomycosis) + Key Features Download Section PDF Listen +++ ++ 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 Download Section PDF Listen +++ ++ 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 + Diagnosis Download Section PDF Listen +++ ++ Potassium hydroxide preparations of pus or skin scrapings are helpful, showing brown, thick-walled, spherical, sometimes septate cells + Treatment Download Section PDF Listen +++ ++ 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