43 - Chromoblastomycosis

Abstract

Chromoblatomycosis is a chronic granulomatous fungal infection of cutaneous and subcutaneous tissues. More common in tropical and subtropical counties including Mexico, Central and South America, Asia, Africa and Oceania. It is caused by the traumatic implantation onto the skin of dimorphic pigmented (dematiaceous) fungi. They produce a characteristic thick-walled sclerotic bodies. The most common agents are Fonsecaea pedrosoi, Phialophora verrucosa and Cladophialophora carrionii. Clinically it may present as plaques, nodules, tumours, cicatricial or verrucous exophytic lesions most commonly on lower legs and feet. Lesions are indolent and slow growing, extending centrifugally, leaving central areas of scarring. It is a difficult-to-treat mycosis, with low cure and high relapse rates. There are no clinical trials to determine the best therapeutic approach. Surgical excision can be used for small and localized lesions. Itraconazole and terbinafine are considered first-line treatments. Dual therapy with the two drugs is recommended alone or in combination with surgery, cryotherapy or thermotherapy.