bubble_chart Overview

Chromoblastomycosis is a chronic granulomatous disease caused by several pigmented fungi that invade the skin and subcutaneous tissues. It is commonly found in tropical and subtropical regions, with frequent occurrences in Shandong, Henan, Guangdong, and other areas in China. The main pathogenic fungi include Cladosporium carrionii, Fonsecaea pedrosoi, and Phialophora verrucosa. The disease often develops after trauma, with skin lesions typically appearing on exposed areas. It is stubborn and persistent, often leading to limb disability.

bubble_chart Clinical Manifestations

1. It is commonly seen in farmers, and patients often have a history of trauma; 2. It frequently occurs on exposed areas such as the limbs; 3. The lesion is unilateral, presenting as nodules or patches with a dirty brown color, surrounded by a purplish-red infiltrative zone. Later, the patches ulcerate, revealing granular granulation tissue. The disease progresses slowly. 4. Symptoms are mild, but it can eventually lead to elephant hide-like swelling. In rare cases, it may spread to the entire skin or even cause brain abscesses or meningitis.

bubble_chart Diagnosis

1. Farmers are commonly affected, often with a history of trauma; 2. Skin lesions frequently occur on exposed areas; 3. Typical skin lesion manifestations are present; 4. Direct microscopy reveals brown clusters of thick-walled spores or septate hyphae, with positive fungal culture; 5. Histopathological examination of the skin lesion (PAS staining) shows brown thick-walled spores within epidermal microabscesses and multinucleated giant cells.

bubble_chart Treatment Measures

Treatment Principles 1. Systemic antifungal drugs; 2. Topical antifungal preparations; 3. Local surgical excision, laser, cryotherapy, thermotherapy, or physical therapy.

Medication Guidelines 1. For early-stage lesions or small, localized lesions, surgical excision, surgical excision with skin grafting, laser, or cryotherapy may be considered. Systemic antifungal therapy is usually required for about 1 month before surgery; 2. For intermediate or advanced-stage lesions or extensive lesions, systemic antifungal therapy is often employed, supplemented with topical antifungal preparations, thermotherapy, or physical therapy; 3. 5-Fc is often combined with other antifungal drugs to reduce side effects and minimize drug resistance; 4. Amphotericin B has significant side effects and is generally reserved for cases where other antifungal treatments have proven ineffective.

bubble_chart Cure Criteria

1. Cure: Skin lesions disappear, with negative fungal direct microscopy and culture once a month for three consecutive times; 2. Improvement: Partial regression of skin lesions, with fungal test results being negative or positive; 3. No cure: No improvement in skin lesions, with positive fungal test results.