What is Chromoblastomycosis? Causes and Treatments

Written by Medicover Team and Medically Reviewed by Dr Girishma J , Dermatologists

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1. Causes 2. Find a Doctor 3. Diagnosis 4. Treatment 5. FAQs

Chromoblastomycosis is a chronic fungal skin infection caused by pigmented fungi that enter the body through cuts or injuries to the skin. It most commonly affects the feet, legs, and hands, especially in people who work in agriculture or frequently come into contact with soil, wood, or plant material. The infection usually develops slowly, producing warty, scaly, or cauliflower-like skin lesions that may enlarge over time.

Diagnosis is confirmed through clinical examination, microscopic evaluation, fungal culture, and skin biopsy. Treatment typically includes long-term antifungal medications, and in some cases, surgery or cryotherapy may be required to remove affected tissue and prevent complications.

What are the Symptoms of Chromoblastomycosis?

Chromoblastomycosis develops slowly over months or years. The infection usually begins as a small, painless skin lesion that gradually enlarges and becomes thickened. If left untreated, it can spread locally and cause chronic skin damage.

Small, painless bump or nodule at the site of fungal entry.
Warty, cauliflower-like, or scaly skin lesions.
Slowly enlarging plaques or raised skin growths.
Itching, mild pain, or tenderness in the affected area.
Crusting, ulceration, or discharge from chronic lesions.
Swelling of the affected limb due to lymphatic involvement.
Skin thickening, scarring, and reduced mobility in severe cases.
Secondary bacterial infections in long-standing lesions.

What are the Causes of Chromoblastomycosis?

Chromoblastomycosis is caused by pigmented (dematiaceous) fungi that enter the skin through cuts, puncture wounds, or other minor injuries. The infection commonly occurs after contact with contaminated soil, wood, thorns, or decaying plant material, particularly in tropical and subtropical regions.

Infection with pigmented fungi such as Fonsecaea, Cladophialophora, and Phialophora species.
Skin injuries caused by thorns, splinters, or sharp plant material.
Direct contact with contaminated soil, wood, or decaying vegetation.
Agricultural, forestry, or outdoor occupations with frequent skin trauma.
Living in tropical or subtropical climates where the fungi are common.
Walking barefoot or working without protective clothing or gloves.
Delayed wound cleaning or untreated skin injuries that allow fungal entry.

When to See a Doctor for Chromoblastomycosis?

If you develop symptoms suggestive of chromoblastomycosis, consult a Dermatologist promptly. Early diagnosis and treatment can help control the infection, prevent its spread, reduce skin damage, and minimize long-term complications.

If you develop a persistent skin bump, nodule, or wart-like growth that gradually enlarges.
If you notice scaly, cauliflower-like, or thickened skin lesions that do not heal.
If you experience itching, pain, swelling, or discharge from chronic skin lesions.
If you develop ulcers, crusting, or recurrent infections in the affected area.
If you have a history of skin injury from thorns, wood, or soil followed by persistent skin changes.
If the affected area becomes swollen or limits the movement of the nearby joint or limb.
If over-the-counter creams or home remedies fail to improve the skin lesions.
If your symptoms persist or worsen, consult a Dermatologist promptly for a comprehensive skin examination, fungal testing, diagnosis, and appropriate treatment.

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How is Chromoblastomycosis Diagnosed?

Diagnosis of chromoblastomycosis is primarily clinical, supported by laboratory investigations. Direct microscopic examination of skin scrapings treated with potassium hydroxide (KOH) reveals characteristic muriform cells.

Culture of the organism on Sabouraud's dextrose agar confirms the diagnosis, although it may take several weeks for fungi to grow. Molecular techniques, such as polymerase chain reaction (PCR), can also aid in diagnosis but are not routinely available in resource-limited settings.

What are the Treatment Options for Chromoblastomycosis?

Treatment of chromoblastomycosis is challenging due to the chronicity and recalcitrance of the infection. A combination of antifungal therapy and surgical intervention is often required for optimal results.

Antifungal Therapy

The mainstay of treatment is antifungal medication, with itraconazole and terbinafine being the most commonly used agents. These medications inhibit fungal cell wall synthesis, leading to cell death. Treatment duration is prolonged, often lasting several months to years, and is determined by clinical and mycological responses.

Surgical Intervention

Surgical methods, such as cryotherapy, excision, and laser therapy, may be employed for small and localized lesions. These interventions aim to remove the bulk of the fungal load, reducing the duration of antifungal therapy. However, surgery is not feasible for extensive disease due to the risk of scarring and recurrence.

Adjunctive Therapies

Adjunctive therapies, including thermotherapy and photodynamic therapy, have shown promise in managing chromoblastomycosis. These methods enhance the antifungal effect and stimulate the host's immune response, promoting lesion resolution.

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How can Chromoblastomycosis be Prevented?

Prevention of chromoblastomycosis involves reducing exposure to soil and plant materials containing the causative fungi. Protective clothing and footwear should be worn during outdoor activities, especially in endemic areas. Early diagnosis and treatment are crucial to prevent disease progression and complications.

What is the Histology of Chromoblastomycosis?

Histologically, chromoblastomycosis is identified by the presence of muriform cells, also known as sclerotic bodies or Medlar bodies. These cells are thick-walled, brown, and round, measuring 4-12 micrometers in diameter, and are pathognomonic for the disease. The inflammatory response typically shows mixed granulomatous and suppurative reaction, with fibrosis occurring in chronic lesions.

Pathology Outlines

Chromoblastomycosis pathology outlines include various stages of lesion development, from early erythematous papules to advanced verrucous plaques and nodules. The lesions may ulcerate, leading to secondary bacterial infections. The disease progresses slowly, and lesions can persist for years if left untreated, causing significant disfigurement and disability.

What is the Clinical Presentation of Chromoblastomycosis?

The clinical manifestations of chromoblastomycosis vary depending on the stage of the disease and the host's immune response. Early lesions appear as small, itchy, and scaly papules that gradually enlarge and become verrucous. Advanced lesions are often hyperkeratotic, with black dots on the surface, representing clusters of fungal elements.

What are the Complications of Chromoblastomycosis?

Complications include secondary bacterial infections, lymphatic obstruction leading to lymphedema, and rarely, malignant transformation into squamous cell carcinoma. The chronic nature of the disease can lead to psychological distress and social stigmatization.