II. Pathophysiology
- Subcutaneous, Granulomatous Fungal Infection (deeper than most Fungal Dermatoses)
- Found in tropical and subtropical regions
- Caused by one of 5 fungal genera (Fonsecaea, Cladophialophora, Exophiala, Phialophora, Rhinocladiella)
- Reddish-brown colored soil saprophytes that inhabit rotting wood
III. History
- Infection follows Puncture Wound (rotten wood splinter)
IV. Findings
- Start as small violet, scaly Papule, Nodule or wart-like growths
- Typically affects the foot or leg
- May affect the hand or wrist in uncommon cases
- May be associated with distal extremity swelling
- Lesions spread as nearby satellite lesions over the course of years
- Lesions may cluster and appear similar to cauliflower
- Skin lesions may ulcerate
V. Labs
-
Potassium Hydroxide (KOH Preparation)
- Reddish-brown clustered fungal cells (sclerotic bodies, muriform bodies, Copper pennies, medlar bodies)
VI. Management
- Mild Chromoblastomycosis
- Surgical excision with 5-mm margins
- Other treatment options include laser and Cryosurgery
- Imiquimod (Aldara)
- Moderate to Severe Chromoblastomycosis
- May be used in combination with local destructive procedures above
- Itraconazole 100 to 200 mg (up to 400 mg) daily for 12 to 24 (up to 36 months)
- May be used in combination with Terbinafine
VII. Complications
- Scarring may impair limb functioning
- Cutaneous Squamous Cell Carcinoma
- Lymphedema
- Bacterial superinfection
VIII. References
- Gladwin, Trattler and Mahan (2014) Clinical Microbiology, Medmaster, Fl, p. 204
- Kurien (2024) Chromoblastomycosis, Stat Pearls +PMID: 29261968 [PubMed]