II. Etiology

III. Pathophysiology

  1. See Blastomycosis
  2. Direct contact of non-intact skin with contaminated soil or decomposing timber

IV. Symptoms

  1. Painful facial lesions (Pustules, ulcers or wart-type lesions)

V. Signs

  1. Distribution: Face (esp. eyebrows)
  2. Verrucous form
    1. Starts as Papule or Pustule with slow enlargement
    2. Later, the lesion forms crust with irregular borders
    3. Secondary Subcutaneous Nodules and abscesses may drain pus
  3. Ulcerative form
    1. Ulcerated lesion with sharp border
    2. Friable red granulation tissue at ulcer base may bleed easily

VI. Diagnosis

  1. Microscopy of purulent discharge with Potassium Hydroxide or Calcofluor stain
  2. Skin biopsy

VII. Differential Diagnosis

VIII. Management

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