CHROMOBLASTOMYCOSIS
INTRODUCTION:
Chromoblastomycosis is a sporadically occurring infection seen in tropical and
subtropical climates caused by a number of different pigmented fungi, the most common of
which are Fonsecaea pedrosoi, Fonsecaea monophora and Cladophialophora carrionii. Other
fungi can also cause chromoblastomycosis.
Chromoblastomycosis can cause disability due to limb enlargement, which may lead to inability
to work and considerable social stigma. Rarely, the fungi that cause chromoblastomycosis can
infect other organs, such as the brain, or lead to skin cancer.
ETIOLOGY:
Chromoblastomycosis is a chronic fungal infection of the skin and subcutaneous tissue
caused by certain fungi. The most common etiological agents of chromoblastomycosis are fungi
belonging to the genera Fonsecaea, Cladophialophora, and Phialophora. These fungi are found in
the environment, particularly in soil and decaying vegetation. When the skin is injured, these
fungi can enter the body and cause infection, leading to the characteristic skin lesions seen in
chromoblastomycosis. Treatment usually involves antifungal medications and, in some cases,
surgical intervention.
SOURCE OF TRANSMISSION:
The primary source of transmission is through traumatic inoculation of the fungal
spores into the skin. This can occur from contact with soil, plant material, or decaying
vegetation, particularly in tropical and subtropical regions where these fungi are endemic.
SIGNS AND SYMPTOMS:
Patients do not report any kind of pain or discomfort during the initial infection. As
the infection spreads, the nodules on the skin become evident.
The infected masses have been reported to appear in five different forms:
◦ Nodular type: Nodules are soft, moderately raised swellings and appear pale pink
or purple, with a smooth or scaly surface. These nodules may further grow into bigger lesions.
◦ Tumoral type: Much bigger, protruding rounded masses that are divided into
smaller lobes appear. These masses may be partially or completely covered with dirty-grey
epidermal remains, scabs and scaly tissue.
◦ Verrucous type: The outermost layer of the epidermis thickens and resembles
common warts. These lesions usually occur along the edges of the feet.
◦ Cicatricial type: These are skin-level lesions, or sometimes depressed due to
scarring after healing. These scarring tissues may cover substantial areas of the body.
◦ Plaque type: This type of lesion is a rare form of clinical presentation. Simple
lesions of various sizes and shapes occur, without the appearance of masses. These lesions may
range from reddish to violet in colour and are scaly on the surface.
PATHOGENESIS:
The pathogenesis of chromoblastomycosis involves the entry of fungal spores from
the environment into the skin through a skin injury, like a cut or a scratch. Once inside the body,
the fungi establish an infection in the skin and subcutaneous tissue. The fungi then form
characteristic structures called sclerotic bodies within the infected tissues. These sclerotic bodies
are important for the diagnosis of chromoblastomycosis. The body's immune response tries to
fight off the infection, leading to the formation of chronic and often disfiguring skin lesions.
Over time, the infection can spread and become more severe if left untreated. Treatment typically
involves antifungal medications to eliminate the fungi and control the infection.
TREATMENT AND MANAGEMENT OF CHROMOBLASTOMYCOSIS:
The treatment and management of CHROMOBLASTOMYCOSIS include:
◦ Antifungal Therapy: Use oral agents like itraconazole or terbinafine for months to
years.
◦ Surgical Interventions: Consider excision, cryosurgery, or laser therapy for
localized lesions.
◦ Combination Therapy: Sometimes, combining oral antifungals may be necessary.
◦ Adjunctive Measures: Topical antifungals and immunotherapy (e.g., interferon-
gamma) can be adjuncts.
DOSES AND MEDICATION:
Doses and medication for CHROMOBLASTOMYCOSIS include
1. Itraconazole:
• Dose: 200-400 mg daily orally.
2. Terbinafine:
• Dose: 500-1000 mg daily orally.
3. Fluconazole:
• Dose: 400-800 mg daily orally.
4. Amphotericin B (for severe cases):
• Dose: 0.5-1 mg/kg/day intravenously.
5. Surgical Treatments:
• Excision, Cryosurgery, Laser Therapy: Used for localized lesions as needed.
These medications are administered under medical supervision, and dosages may vary based on
patient response and tolerability.
FIRST CHOICE OF DRUG AND ALTERNATIVE WITH ROUTE,FREQUENCY WITH
REFERENCE OF “MDPI”
ChatGPT
For the treatment of chromoblastomycosis, the first-choice drugs and their alternatives, along
with their routes, frequencies, and a reference for further reading are as follows:
1. First Choice Drug: Itraconazole
• Route: Oral
• Dose: 200-400 mg daily
• Reference:
• MDPI Reference: "Treatment of Chromoblastomycosis" by Elmer et al.
Alternative Drug: Terbinafine
• Route: Oral
• Dose: 500-1000 mg daily
• Reference:
• MDPI Reference: "Treatment of Chromoblastomycosis" by Elmer et al.
PREVENTION :
◦ Protective clothing
◦ Avoid barefoot walking
◦ Skin care
◦ Appropriate treatment
◦ Hygiene maintenance
REFRENCES:
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3. [Link]
4. Chatgpt / AI