Chromoblastomycosis

Last Updated: 2020-08-12

Author(s): Anzengruber F., Navarini A.

ICD11: 1F24

  • Rudolph 1914
  • Lane 1915
  • Medlar 1915

Chromomycosis.

Worldwide occurring fungal infection mainly of the lower extremities and hands.

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

  • Pathogen
  • 6 species of fungi with strong structural similarities:
    • Phialophora verrucosa jeanselmii or - gougerotii
    • Fonsecae pedrosoi
    • Fonsecae compacta
    • Botromyces caespitosus
    • Cladosporium carrionii
    • Rhinocladiella aquaspersa
  • The fungi are usually found on wood or plants. Small skin lesions lead to inoculation. In rare cases insect bites may also lead to an infection.

Initially a slightly painful, pruriginous papule, plaque or pustule may appear in the area of the inoculation site. In the course of time, there is a progression in size and the development of erythematous, verruziform, granulomatous, partly ulcerated, crusty nodules. Secondary impetiginizations are observed more frequently.

  • Clinical features
  • Pathogen detection (myco. smear, biopsy)

  • Lower extremity > upper extremity or face
  • Especially lower legs, feet, but also hands (gardening)

Mostly chronic course.

  • Therapy is often frustrating due to resistance to therapy
  • Surgical removal
  • Cryotherapy
  • Heat therapy

 

  • The therapy should be carried out with both topical and systemic antimycotics!


Topical therapy

  • for example: Ketoconazole cream (2%)


Systemic therapy

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

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  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.