By Gary M. White, MD
Courtesy Dr. Kaess
Chromomycosis (aka Chromoblastomycosis) represents a chronic fungal infection caused by one of the dematiaceous (darkly pigmented) hyphomycetes: Fonsecaea pedrosoi, Phialophora verrucosa, Cladosporium carrionii, Fonsecaea compacta or Rhinocladdiella aquaspersa. The organism has been found in soil or wood and infection is thought precipitated by trauma, e.g. from a splinter. Adult, male agricultural workers are most commonly affected. This infection is widespread including North, Central and South America, Europe, South Africa and Australia. KOH may show the organism. These medlar bodies are quite hardy and in one study survived for 11-18 months in surface scrapings stored in a jar (IJD 1996;35;96).
A slow growing verrucous nodule(s) or plaque(s) on the dorsa of the foot, ankle and leg is typical.
Histologic examination shows typical brown cells which divide by splitting, often called sclerotic cells or Medlar bodies.
Consultation with an infectious disease specialist should be made. Multiple therapies may be tried as none is uniformly effective in all cases. Surgery is the best option. Other treatment options include terbinafine, itraconazole, cryosurgery, diathermy, and electrodesiccation.
A 65-year-old man with a renal transplant developed over 3 years asymptomatic lesion on the right lower leg. The article contains a nice picture of a hyperpigmented, indurated nodule several centimeters in diameter on the right leg. Dermatology Online Journal 17(10)
Non-healing verrucous plaque over upper limb for 1 year in a tea garden worker Dermatology Online Journal 19(3)
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