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For further information, see CMDT Part 38-13: Chromoblastomycosis (Chromomycosis)

KEY FEATURES

  • A chronic, principally tropical skin and subcutaneous infection

  • Usually affects older men who are agricultural workers

  • Caused by several species of closely related black molds

  • Organisms from the genera Fonsecaea, Cladiophialophora, Exophiala, Phialophora, Rhinocladiella, and Veronaea are most common etiologic agents

CLINICAL FINDINGS

  • Lesions usually follow implantation 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

    • Cicatricial (atrophic)

  • 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

  • Punch or excisional biopsy specimens are also sensitive for diagnosis

TREATMENT

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

  • Terbinafine (500–1000 mg/d orally) may be equivalent to itraconazole; the two may be useful in combination

  • 5-fluorocytosine (50–150 mg/kg/d orally) along with one of the above drugs also has been shown to be active, but patients require careful monitoring for adverse events

  • Adding immunomodulating drugs, eg, topical imiquimod or oral acitretin (0.25 mg/kg/d), to conventional antifungal therapy may be beneficial

  • Surgery or photodynamic therapy combined with antifungal drugs has also been used successfully

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