Chromoblastomycosis

Chromoblastomycosis (CBM) is a neglected, chronic, occupational cutaneous, and subcutaneous mycosis. It was considered the second implantation mycosis, usually related to black or melanic fungi. Various agents predominate, including Fonsecaea pedrosoi and Cladophialophora carrionii; both appear in warm tropical climates and humid and semi-arid regions, respectively. It is a classic inoculation disease that initially affects the cutaneous integument, mainly after traumatic implantation in peasants and rural workers; most reports come from Brazil and Madagascar. Their frequency has increased due to ecotourism travels, humanitarian workers, archaeologists, and immigrants. The most common clinical forms include nodular, tumoral, verrucous, cicatricial, and superficial plaque; however, the most frequent type is the verrucous and nodular form usually located on the lower limbs clinically resembling tuberculosis verrucosa cutis and cutaneous leishmaniasis. Diagnostic resources include mycological tests, direct examination (KOH), and histopathology, showing tuberculoid granulomas with muriform cells; culture supports the diagnosis, allowing the proper agent identification (slow-growing black fungi). Since no consensus guidelines are available, there is no treatment of choice; however, conventional surgery and oral antifungals such as itraconazole, often combined with cryosurgery, are effective and the most used options.