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Chromoblastomycosis Medication

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
Updated: Jun 22, 2016

Medication Summary

Overall results of the various treatments in one Mexican study were as follows: 31% of the conditions were cured, 57% improved, and 12% did not respond to treatment. Optimal results were obtained with cryosurgery for small lesions; itraconazole for large ones; and, in some cases, the combination of both.[77] Combination therapy with itraconazole and terbinafine during the early stages of treatment of chromoblastomycosis caused by F monophora has been suggested.[78] .

Photodynamic therapy (PDT) using 5-aminolevulinic acid (ALA) irradiation may be adjunctive, with positive clinical improvement obtained when voriconazole at 200 mg was combined with terbinafine at 250 mg in treating one patient with refractory chromoblastomycosis.[73]

Chromoblastomycosis may also be cured by prolonged topical application of tolerable heat from pocket warmers. It may take as long as 6 months or more.[79]

As there is no standard treatment and high rates of relapse, topical imiquimod has been used with substantial improvement documented both with and without concurrent oral antifungal therapy.[80]



Class Summary

The mechanism of action usually involves inhibiting pathways (eg, enzymes, substrates, transport) necessary for sterol/cell membrane synthesis or altering the permeability of the cell membrane (polyenes) of the fungal cell.

Itraconazole (Sporanox)


Itraconazole has fungistatic activity. It is a synthetic triazole antifungal agent that slows fungal cell growth by inhibiting cytochrome P450–dependent synthesis of ergosterol, a vital component of fungal cell membranes. Results may take several weeks to be noted, and treatment may last several months or years.

Terbinafine (Lamisil)


Terbinafine is a member of allylamine family and is believed to be a fungicidal agent. It inhibits ergosterol synthesis via squalene epoxidase, resulting in decreased ergosterol levels and increased concentrations of squalene.

Flucytosine (Ancobon)


5-FC has proven useful when used in association with oral itraconazole. It should not be used as monotherapy.

Contributor Information and Disclosures

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Jeffrey P Callen, MD Professor of Medicine (Dermatology), Chief, Division of Dermatology, University of Louisville School of Medicine

Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, American College of Rheumatology

Disclosure: Received income in an amount equal to or greater than $250 from: XOMA; Biogen/IDEC; Novartis; Janssen Biotech, Abbvie, CSL pharma<br/>Received honoraria from UpToDate for author/editor; Received honoraria from JAMA Dermatology for associate editor and intermittent author; Received royalty from Elsevier for book author/editor; Received dividends from trust accounts, but I do not control these accounts, and have directed our managers to divest pharmaceutical stocks as is fiscally prudent from Stock holdings in various trust accounts include some pharmaceutical companies and device makers for i inherited these trust accounts; for: Celgene; Pfizer; 3M; Johnson and Johnson; Merck; Abbott Laboratories; AbbVie; Procter and Gamble; Amgen.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.


Eugeniusz Baran, MD, PhD Professor, Department of Dermatology, Venereology and Allergology, Head, Clinic of Dermatology and Venereology, Wroclaw Medical University, Poland

Eugeniusz Baran, MD, PhD is a member of the following medical societies: European Confederation of Medical Mycology and International Society for Human and Animal Mycology

Disclosure: Nothing to disclose.

Luiz Guilherme M Castro, MD Supervising Physician, Master and Doctor in Dermatology, Division of Dermatology, Hospital Das Clinicas, University of São Paulo, Brazil

Luiz Guilherme M Castro is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

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Sclerotic cells on a potassium hydroxide preparation.
Micromorphology of Cladosporium carrionii (left) and Fonsecaea pedrosoi (right), the 2 most commonly isolated agents in chromoblastomycosis.
Chromoblastomycosis, tumoral form. Chronic disease led to elephantiasis and involvement of the entire lower limb.
Plaque lesion on the foot. The verrucous aspect of the lesion differentiates it from other infectious dermatoses that may present as a verrucous lesion, namely, cutaneous leishmaniasis, sporotrichosis, cutaneous tuberculosis, and cutaneous mycobacteriosis.
Culture of Fonsecaea pedrosoi on Sabouraud agar. The black velvety colony has the same macroscopic appearance as the colonies of other chromoblastomycosis-causing agents (eg, Cladosporium carrionii, Fonsecaea compacta, Phialophora verrucosa, Rhinocladiella aquaspersa, Exophiala species).
Hematoxylin and eosin–stained section shows typical sclerotic cells inside an abscess. Sclerotic cells present as round, thick-walled, cigar-colored structures.
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