Chromoblastomycosis is a deep fungal infection caused by several pigmented fungi, primarily affecting the skin but occasionally involving internal organs as well.

bubble_chart Etiology

The causative agents of this disease are Fonsecaea pedrosoi, Fonsecaea compacta, Phialophora verrucosa, Cladosporium carrionii, and Exophiala dermatitidis, with Fonsecaea pedrosoi being the most common. However, cerebral abscess syndrome is caused by another dematiaceous fungus, Cladosporium trichoides; the subcutaneous cystic type is caused by Phialophora gougerotii and Phialophora zengii.

Chromoblastomycosis fungi are widely distributed in nature, often saprophytic in humid areas, decaying wood, or plants. The occurrence of the disease is closely related to trauma, as the pathogenic fungi can invade the skin through wounds to cause infection. Generally, it is not directly contagious between people. When the body's immune function is compromised, hematogenous dissemination may occur, affecting internal organs. The disease progression is also related to local tissue immunity, as some lesions may gradually heal naturally without treatment after skin damage occurs.

Chromoblastomycosis is sporadically reported worldwide but is particularly common in tropical and subtropical regions. In China, it was first discovered in Shandong Province in 1951, followed by case reports in Jilin, Liaoning, Hebei, Henan, Shaanxi, Anhui, Jiangsu, Jiangxi, Guangdong, Guangxi, Beijing, and Shanghai. Among these, Zhangqiu in Shandong and Xingyang in Henan are the main endemic areas. This disease is a chronic sexually transmitted disease, often persisting for years or even decades without cure. Ultimately, it can lead to limb disability in patients, and severe cases may even be life-threatening. Therefore, the prevention and treatment of chromoblastomycosis should be taken seriously.

TCM can effectively treat dry eye syndrome, floaters, retinopathy, and various chronic eye diseases

Chromomycosis is more common in adult males, with patients primarily being farmers or construction workers. The most frequently affected areas reported abroad are the lower limbs, especially the dorsum of the foot and the calf, but in patients from Zhangqiu, Shandong, China, the wrist is the most common site.

The initial skin lesions appear as papules or blisters, which gradually evolve into patches or nodules, eventually becoming cauliflower-like or papillomatous and significantly elevated above the normal skin. These lesions often ulcerate due to trauma or secondary infection. Scant purulent discharge may be observed between the lesions, often emitting a foul odor. Direct microscopic examination of the discharge often reveals brownish-yellow, round, thick-walled fungal spores.

The lesions tend to cluster densely, varying in size and sometimes merging with one another, with some rashes exhibiting a satellite distribution. The color of the lesions is dark red or purple. Chronic lymphatic edema or elephantiasis may develop in the affected limb due to lymphatic obstruction. Additionally, during the slow progression of the disease, partial spontaneous healing of the lesions may occur, leaving behind scars and pigmentation.

The disease follows a chronic course, persisting for years or even decades without resolution, though general health may remain relatively unaffected. Without active and persistent treatment, it may ultimately lead to limb disability and loss of labor capacity. Some patients may develop visceral involvement with corresponding symptoms.

Cerebral abscess syndrome often results from hematogenous dissemination of the pathogen to the brain, typically seen in patients with weakened constitutions or those on long-term corticosteroid therapy. The prognosis for such patients is poor.

TCM's treatment of atopic dermatitis is more comprehensive, fundamental, non-toxic and effective than Western medicine's symptomatic treatment

For influenza, enterovirus, and various viral colds, TCM is more refined, non-toxic, and effective than modern medicine

bubble_chart Diagnosis

In addition to relying on medical history and clinical symptom characteristics, histopathology and fungal examination are of significant importance for the definitive diagnosis of this disease. Pathological sections may reveal brownish-yellow, thick-walled, round fungal spores within the infiltrating Langerhans cells or dermal tissue; direct microscopic examination of smears from purulent secretions at the lesion site can also detect the aforementioned fungal spores. Fungal culture may also yield positive results.

This disease should be differentiated from verrucous skin subcutaneous nodules, syphilis, squamous cell carcinoma, and sporotrichosis.

bubble_chart Treatment Measures

1. In case of skin injury during rural labor, the wound should be carefully treated.
2. Internal Therapy
   1. 5-Fluorocytosine: This drug can be taken orally at a dose of 100mg per kilogram per day, which may be effective. However, it needs to be used continuously for a long period until the rash disappears.
   2. Thiabendazole: 2 grams daily for 3-6 months may show results.
   3. Garlic extract intravenous drip or oral imidazole drugs. Antifungal agents such as Globoroseomycin, Lushanmycin, and Amphotericin B can be tried as appropriate.
   4. Potassium iodide taken orally, gradually increasing the dose to 3-6 grams, divided into 3-4 doses, until the skin lesions subside and fungal tests turn negative. It is reported that the efficacy of this drug for this condition is not as good as for sporotrichosis.
3. External Therapy
   1. Surgical removal may be considered for early-stage skin lesions.
   2. Electrocoagulation, laser, and high-frequency electric knives are only suitable for smaller lesions.
   3. Local heat therapy: Given that chromomycosis stops growing above 38°C, local treatments such as wax therapy or light bulb heating can be used to raise the temperature of the affected area to 50-60°C, once daily for 30 minutes each time, which can yield good results. This therapy is particularly suitable for implementation in rural areas.
   4. Amphotericin B 10-50mg can be injected locally (5mg of the drug mixed with 1ml of 2% Novocaine). Once a week for three months may prove effective. This therapy can also be substituted with Lushanmycin.
   5. Topical application of Thiabendazole dimethyl sulfoxide solution or 10% 5-Fluorocytosine ointment may also be effective.