Chromoblastomycosis

• Rudolph 1914
• Lane 1915
• Medlar 1915

Chromomycosis.

World-wide fungal infection mainly of the lower extremities and hands.

• Worldwide, but mainly found in South America, the southern USA, Europe and Russia
• Mostly middle-aged men
• Mainly occurring in rural areas

• Pathogen
• 6 fungal species with strong structural similarities:
  • Phialophora verrucosa jeanselmii and - gougerotii
  respectively
  • Fonsecae pedrosoi
  • Fonsecae compacta
  • Botromyces caespitosus
  • Cladosporium carrionii
  • Rhinocladiella aquaspersa

• The fungi are usually found on wood or plants. Inoculation occurs through small skin lesions. Possibly, in rare cases, insect bites can also lead to infection

Initially, a slightly dull, pruritic papule, plaque or pustule may appear in the area of the inoculation site. In the course of the disease, the lesions progress in size and develop erythematous, verrucous, granulomatous, sometimes ulcerated, crusty nodules. Secondary impetiginisation is frequently observed

• clinic
• Detection of pathogens (myco. smear, biopsy)

• Lower extremity > upper extremity or face
• In particular lower leg, feet, but also hands (gardening)

Mostly chronic course.

• Therapy is often frustrating due to resistance to treatment

• Operative removal
• Cryotherapy
• Heat therapy

• Therapy should be carried out with both topical and systemic antifungals!

Topical therapy

• e.g.: Ketoconazole cream (2%)

Systemic therapy

• Itraconazole p.o. 100-200 mg 1x tgl. for 6-20 months (success rate approx. 65%)
• Alternative: Fluconazole p.o. 50 mg 1x tgl. for 14 days
• Alternative: Terbinafine p.o.500 mg 1x tgl. for 6-12 months
• Alternative: Posaconazole p.o. 400 mg 2x tgl.

1. Bonifaz A, Carrasco-Gerard E, Saul A. Chromoblastomycosis: clinical and mycologic experience of 51 cases. Mycoses 2001;44:1-7.
2. Bonifaz A, Saúl A, Paredes‐Solis V, Araiza J, Fierro‐Arias L. Treatment of chromoblastomycosis with terbinafine: Experience with four cases. Journal of Dermatological Treatment 2005;16:47-51.
3. Elgart GW. CHROMOBLASTOMYCOSIS. Dermatologic Clinics 1996;14:77-83.
4. Tuffanelli L, Milburn PB. Treatment of chromoblastomycosis. Journal of the American Academy of Dermatology 1990;23:728-32.
5. Wortman PD. Concurrent chromoblastomycosis caused by Fonsecaea pedrosoi and actinomycetoma caused by Nocardia brasiliensis. Journal of the American Academy of Dermatology 1995;32:390-2.
6. Yu R. Successful treatment of chromoblastomycosis with itraconazole. Mycoses 1995;38:79-83.