Chromoblastomycosis


Chromoblastomycosis

Description, Causes and Risk Factors:

A localized chronic mycosis of the skin and subcutaneous tissues characterized by skin lesions so rough and irregular as to present a cauliflowerlike appearance; caused by dematiaceous fungi such as Phialophora verrucosa, Exophiala (wangiella) dermatitidis, Fonsecaea pedrosoi, F. compacta, and Cladosporium carrionii; fungal cells resembling copper pennies form rounded sclerotic bodies in tissue, with epidermal hyperplasia and intraepidermal microabscesses.

Alternative Name: Chromomycosis.

ICD-9-CM: 117.2.

Chromoblastomycosis

Chromoblastomycosis is a chronic, soft-tissue fungal infection commonly caused by Fonsecaea pedrosoi, Phialophora verrucosa, Cladosporium carrionii, or F. compacta. The infection occurs in tropical or subtropical climates and often in rural areas.

Lesions of chromoblastomycosis are most often found on exposed parts of the body and usually start a small scaly papules or nodules which are painless but may be itchy. Satellite lesions may gradually arise and as the disease develops rash-like areas enlarge and become raised irregular plaques that are often scaly or verrucose. In long standing infections, lesions may become tumorous and even cauliflower-like in appearance. Other prominent features include epithelial hyperplasia, fibrosis and microabscess formation in the epidermis. Chromoblastomycosis must be distinguished from other cutaneous fungal infections such as blastomycosis, lobomycosis, paracoccidioidomycosis and sporotrichosis. It may also mimic protothecosis, leishmaniasis, verrucose tuberculosis, certain leprous lesions and syphilis. Mycological and histopathological investigations are essential to confirm the diagnosis.

Diagnosis:

Diagnosis: Microscopy and culture of scrapings or pus swabs suggest the diagnosis. There may be typical thick-walled dark-brown cells on skin biopsy.

Laboratory tests: Clusters of characteristic thick-walled brown 'sclerotic' (hard) cells are seen on microscopy. Culture at 25-30 degrees celsius grows olive-green to black fungal colonies after one or two weeks.

Treatment Options:

The treatment of chromoblastomycosis has been exceedingly difficult. Successful surgical excision requires the removal of a margin of uninfected tissue to prevent local dissemination. Flucytosine with or without thiabendazole has been extensively used in the past. However both itraconazole [400 mg/day] and terbinafine [500 mg/ day] for 6 to 12 months have been used successfully for the treatment of chromoblastomycosis.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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