CASE AND RESEARCH LETTERS Chromoblastomycosis: Response to Combination Therapy With Cryotherapy and Terbinafine

Chromomycosis or chromoblastomycosis is a chronic deep skin mycosis that affects the skin and subcutaneous tissue and is caused by fungi from the Dematiaceae family, which are imperfect fungi that produce pigments similar to melanin. Several species are known to cause chromoblastomycosis; all have low virulence and produce similar clinical manifestations. The most common species is Fonsecaea pedrosoi, followed by Phialophora verrucosa and Cladophialophora carrionii. Soil and plant debris are natural reservoirs for these fungi, and the common mode of transmission is traumatic inoculation whereby contaminated organic matter enters the skin through a wound. There is no established treatment for chromoblastomycosis but various treatment options have been attempted given the refractory nature of the condition. The choice of treatment is generally guided by clinical, mycologic, and histopathologic criteria. We describe a case of imported chromoblastomycosis, a disease rarely seen in Spain, that had been present for many years and was resolved with combination therapy. The patient was a 50-year-old construction worker from Brazil who had been living in Catalonia, Spain for a year. He had a history of hypertension and presented with mildly pruritic and occasionally painful lesions on the arm and elbow that had been present for 20 years. The lesions had grown progressively and centrifugally and had never completely healed. The patient recalled having been injured with a nail before the lesions appeared. He had attempted treatment with several topical antifungal drugs, with no improvement. He was not on any regular medication.