Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.


Flavio Queiroz-Telles, MD, PhD
Section Editor
Ted Rosen, MD
Deputy Editor
Abena O Ofori, MD


Chromoblastomycosis (also known as chromomycosis) is a chronic, indolent, granulomatous fungal disease caused by the transcutaneous inoculation of propagules (spores) from several species of melanized fungi. Chromoblastomycosis occurs in tropical and subtropical climates and is one of the most common endemic implantation (subcutaneous) mycoses.

The infection begins at the site of inoculation, affects the cutaneous and subcutaneous tissues, and exhibits diverse clinical findings. Early disease often presents as erythematous macules or papules that develop verrucous or hyperkeratotic features (picture 1I). Without treatment, the infection slowly progresses to larger areas of skin involvement with nodular, verrucous, tumoral, plaque, or scar-like morphologies (picture 1A-E). Severe disease can be associated with tissue fibrosis and lymphedema, leading to physical disability (picture 2).

The diverse clinical findings of chromoblastomycosis mimic other infectious or noninfectious diseases. The diagnosis is confirmed through the identification of characteristic fungal elements called muriform cells (also known as sclerotic bodies or Medlar bodies) with a potassium hydroxide preparation or skin biopsy (picture 3).

Although early, small lesions of chromoblastomycosis can be treated with surgical removal, long-term oral antifungal therapy is the treatment of choice for more extensive disease. Severe disease is often refractory to treatment.

The clinical features, diagnosis, and management of chromoblastomycosis will be reviewed here. Several other subcutaneous mycoses are reviewed separately.

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Jul 28, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Queiroz-Telles F, de Hoog S, Santos DW, et al. Chromoblastomycosis. Clin Microbiol Rev 2017; 30:233.
  2. De Hoog GS, Attili-Angelis D, Vicente VA, et al. Molecular ecology and pathogenic potential of Fonsecaea species. Med Mycol 2004; 42:405.
  3. Yaguchi T, Tanaka R, Nishimura K, Udagawa S. Molecular phylogenetics of strains morphologically identified as Fonsecaea pedrosoi from clinical specimens. Mycoses 2007; 50:255.
  4. Badali H, Gueidan C, Najafzadeh MJ, et al. Biodiversity of the genus Cladophialophora. Stud Mycol 2008; 61:175.
  5. Najafzadeh MJ, Gueidan C, Badali H, et al. Genetic diversity and species delimitation in the opportunistic genus Fonsecaea. Med Mycol 2009; 47:17.
  6. Sun J, Najafzadeh MJ, Gerrits van den Ende AH, et al. Molecular characterization of pathogenic members of the genus Fonsecaea using multilocus analysis. PLoS One 2012; 7:e41512.
  7. Najafzadeh MJ, Rezusta A, Cameo MI, et al. Successful treatment of chromoblastomycosis of 36 years duration caused by Fonsecaea monophora. Med Mycol 2010; 48:390.
  8. Badali H, Fernández-González M, Mousavi B, et al. Chromoblastomycosis due to Fonsecaea pedrosoi and F. monophora in Cuba. Mycopathologia 2013; 175:439.
  9. Najafzadeh MJ, Sun J, Vicente V, et al. Fonsecaea nubica sp. nov, a new agent of human chromoblastomycosis revealed using molecular data. Med Mycol 2010; 48:800.
  10. de Azevedo CM, Gomes RR, Vicente VA, et al. Fonsecaea pugnacius, a Novel Agent of Disseminated Chromoblastomycosis. J Clin Microbiol 2015; 53:2674.
  11. Gugnani HC, Egere JU, Suseelan AV, et al. Chromomycosis caused by Philaphora pedrosoi in eastern Nigeria. J Trop Med Hyg 1978; 81:208.
  12. Borelli D. [Acrotheca aquaspersa nova, new species agent of chromomycosis]. Acta Cient Venez 1972; 23:193.
  13. Naka W, Harada T, Nishikawa T, Fukushiro R. A case of chromoblastomycosis: with special reference to the mycology of the isolated Exophiala jeanselmei. Mykosen 1986; 29:445.
  14. Barba-Gómez JF, Mayorga J, McGinnis MR, González-Mendoza A. Chromoblastomycosis caused by Exophiala spinifera. J Am Acad Dermatol 1992; 26:367.
  15. Zeng JS, Sutton DA, Fothergill AW, et al. Spectrum of clinically relevant Exophiala species in the United States. J Clin Microbiol 2007; 45:3713.
  16. Queiroz-Telles F, Nucci M, Colombo AL, et al. Mycoses of implantation in Latin America: an overview of epidemiology, clinical manifestations, diagnosis and treatment. Med Mycol 2011; 49:225.
  17. Esterre P, Andriantsimahavandy A, Ramarcel ER, Pecarrere JL. Forty years of chromoblastomycosis in Madagascar: a review. Am J Trop Med Hyg 1996; 55:45.
  18. Al-Doory Y. Chromomycosis. In: Occupational Mycoses, Di Salvo AF (Ed), Lea & Febiger, Philadelphia 1983. p.95.
  19. Mehregan AH, Rudner EJ. Implantation dermatosis. Wood splinter with fungus contamination. J Cutan Pathol 1980; 7:330.
  20. Riddel CE, Surovik JG, Chon SY, et al. Fungal foes: presentations of chromoblastomycosis post-hurricane Ike. Cutis 2011; 87:269.
  21. Bandino JP, Hang A, Norton SA. The Infectious and Noninfectious Dermatological Consequences of Flooding: A Field Manual for the Responding Provider. Am J Clin Dermatol 2015; 16:399.
  22. Tschen JA, Knox JM, McGavran MH, Duncan WC. Chromomycosis. The association of fungal elements and wood splinters. Arch Dermatol 1984; 120:107.
  23. Rubin HA, Bruce S, Rosen T, McBride ME. Evidence for percutaneous inoculation as the mode of transmission for chromoblastomycosis. J Am Acad Dermatol 1991; 25:951.
  24. Salgado CG, da Silva JP, Diniz JA, et al. Isolation of Fonsecaea pedrosoi from thorns of Mimosa pudica, a probable natural source of chromoblastomycosis. Rev Inst Med Trop Sao Paulo 2004; 46:33.
  25. Bonifaz A, Carrasco-Gerard E, Saúl A. Chromoblastomycosis: clinical and mycologic experience of 51 cases. Mycoses 2001; 44:1.
  26. Silva JP, de Souza W, Rozental S. Chromoblastomycosis: a retrospective study of 325 cases on Amazonic Region (Brazil). Mycopathologia 1998-1999; 143:171.
  27. McGinnis MR. Chromoblastomycosis and phaeohyphomycosis: new concepts, diagnosis, and mycology. J Am Acad Dermatol 1983; 8:1.
  28. Vicente VA, Najafzadeh MJ, Sun J, et al. Environmental siblings of black agents of human chromoblastomycosis. Fungal Divers 2014; 65:47.
  29. Seyedmousavi S, Netea MG, Mouton JW, et al. Black yeasts and their filamentous relatives: principles of pathogenesis and host defense. Clin Microbiol Rev 2014; 27:527.
  30. Nosanchuk JD, Casadevall A. The contribution of melanin to microbial pathogenesis. Cell Microbiol 2003; 5:203.
  31. Langfelder K, Streibel M, Jahn B, et al. Biosynthesis of fungal melanins and their importance for human pathogenic fungi. Fungal Genet Biol 2003; 38:143.
  32. Salgado CG. Fungal x host interactions in Chromoblastomycosis: what we have learned from animal models and what is yet to be solved. Virulence 2010; 1:3.
  33. Rosen T, Gyorkey F, Joseph LM, Batres E. Ultrastructural features of chromoblastomycosis. Int J Dermatol 1980; 19:461.
  34. Nimrichter L, Barreto-Bergter E, Mendonça-Filho RR, et al. A monoclonal antibody to glucosylceramide inhibits the growth of Fonsecaea pedrosoi and enhances the antifungal action of mouse macrophages. Microbes Infect 2004; 6:657.
  35. Queiroz-Telles F, Esterre P, Perez-Blanco M, et al. Chromoblastomycosis: an overview of clinical manifestations, diagnosis and treatment. Med Mycol 2009; 47:3.
  36. Tsuneto LT, Arce-Gomez B, Petzl-Erler ML, Queiroz-Telles F. HLA-A29 and genetic susceptibility to chromoblastomycosis. J Med Vet Mycol 1989; 27:181.
  37. Yegres-Rodriguez J, Richard-Yegres N, Yegres F, Rodriguez-Lerralde A. Cromomicosis: susceptibilidad genetica en grupos familiares de la zona endémica en Venezuela. Acta Cient Venez 1992; 43:98.
  38. Liang P, Wang X, Wang R, et al. CARD9 deficiencies linked to impaired neutrophil functions against Phialophora verrucosa. Mycopathologia 2015; 179:347.
  39. Wang X, Wang W, Lin Z, et al. CARD9 mutations linked to subcutaneous phaeohyphomycosis and TH17 cell deficiencies. J Allergy Clin Immunol 2014; 133:905.
  40. Lanternier F, Pathan S, Vincent QB, et al. Deep dermatophytosis and inherited CARD9 deficiency. N Engl J Med 2013; 369:1704.
  41. Gavino C, Cotter A, Lichtenstein D, et al. CARD9 deficiency and spontaneous central nervous system candidiasis: complete clinical remission with GM-CSF therapy. Clin Infect Dis 2014; 59:81.
  42. Grumach AS, de Queiroz-Telles F, Migaud M, et al. A homozygous CARD9 mutation in a Brazilian patient with deep dermatophytosis. J Clin Immunol 2015; 35:486.
  43. Queiroz-Telles F, Santos DW, Pedroso C. Fungal infections of implantation (chromoblastomycosis, mycetoma, entomophthoramycosis, and lacaziosis). In: Diagnosis and Treatment of Fungal Infections, 2nd, Hospenthal DR, Rinaldi MG (Eds), Springer International Publishing, 2015. p.271.
  44. Mugleston BJ, Usatine RP, Rosen T. Wide Morphologic Variability of Chromoblastomycosis in the Western Hemisphere. Skinmed 2016; 14:423.
  45. Batres E, Wolf JE Jr, Rudolph AH, Knox JM. Transepithelial elimination of cutaneous chromomycosis. Arch Dermatol 1978; 114:1231.
  46. Zaias N. Chromoblastomycosis: A superficial minimycetoma. In: Proceedings of the IV International Conference on the Mycoses, Pan American Health Organization, Washington, D.C. 1978. p.17.
  47. Esterre P, Risteli L, Ricard-Blum S. Immunohistochemical study of type I collagen turn-over and of matrix metalloproteinases in chromoblastomycosis before and after treatment by terbinafine. Pathol Res Pract 1998; 194:847.
  48. Ricard-Blum S, Hartmann DJ, Esterre P. Monitoring of extracellular matrix metabolism and cross-linking in tissue, serum and urine of patients with chromoblastomycosis, a chronic skin fibrosis. Eur J Clin Invest 1998; 28:748.
  49. Queiroz-Telles F, Santos DW. Challenges in the therapy of chromoblastomycosis. Mycopathologia 2013; 175:477.
  50. Rojas OC, González GM, Moreno-Treviño M, Salas-Alanis J. Chromoblastomycosis by Cladophialophora carrionii associated with squamous cell carcinoma and review of published reports. Mycopathologia 2015; 179:153.
  51. Azevedo CM, Marques SG, Santos DW, et al. Squamous cell carcinoma derived from chronic chromoblastomycosis in Brazil. Clin Infect Dis 2015; 60:1500.
  52. Vyas MC, Joshi YR, Bhargava N, et al. Cerebral chromoblastomicosis--a rare case report of cerebral abscess and brief review of literature--a case report. Indian J Pathol Microbiol 2000; 43:81.
  53. Camara-Lemarroy CR, Soto-Garcia AJ, Preciado-Yepez CI, et al. Case of chromoblastomycosis with pulmonary involvement. J Dermatol 2013; 40:746.
  54. Banerjee U, Mohapatra AK, Sarkar C, Chaudhery R. Cladosporiosis (cerebral phaeohyphomycosis) of brain--a case report. Mycopathologia 1989; 105:163.
  55. Khan I, Khan AR, Khan MS. Clinicopathological study of cutaneous chromoblastomycosis in Pakistan. Journal of Pakistan Association of Dermatologists 2012; 22:122.
  56. Rippon JW. Chromoblastomycosis and related dermal infections caused by dematiaceous fungi. In: Medical Mycology: The Pathogenic Fungi and the Pathogenic Actinomycetes, 2nd, WB Saunders, Philadelphia 1982. p.249.
  57. Esterre P, Jahevitra M, Andriantsimahavandy A. Humoral immune response in chromoblastomycosis during and after therapy. Clin Diagn Lab Immunol 2000; 7:497.
  58. Vidal MS, Castro LG, Cavalcante SC, Lacaz CS. Highly specific and sensitive, immunoblot-detected 54 kDa antigen from Fonsecaea pedrosoi. Med Mycol 2004; 42:511.
  59. Gupta AK, Taborda PR, Sanzovo AD. Alternate week and combination itraconazole and terbinafine therapy for chromoblastomycosis caused by Fonsecaea pedrosoi in Brazil. Med Mycol 2002; 40:529.
  60. Pradinaud R, Bolzinger T. Treatment of chromoblastomycosis. J Am Acad Dermatol 1991; 25:869.
  61. Antonello VS, Appel da Silva MC, Cambruzzi E, et al. Treatment of severe chromoblastomycosis with itraconazole and 5-flucytosine association. Rev Inst Med Trop Sao Paulo 2010; 52:329.
  62. Andrade TS, Castro LG, Nunes RS, et al. Susceptibility of sequential Fonsecaea pedrosoi isolates from chromoblastomycosis patients to antifungal agents. Mycoses 2004; 47:216.
  63. Queiroz-Telles F, Purim KS, Fillus JN, et al. Itraconazole in the treatment of chromoblastomycosis due to Fonsecaea pedrosoi. Int J Dermatol 1992; 31:805.
  64. Ungpakorn R, Reangchainam S. Pulse itraconazole 400 mg daily in the treatment of chromoblastomycosis. Clin Exp Dermatol 2006; 31:245.
  65. Kumarasinghe SP, Kumarasinghe MP. Itraconazole pulse therapy in chromoblastomycosis. Eur J Dermatol 2000; 10:220.
  66. Borelli D. A clinical trial of itraconazole in the treatment of deep mycoses and leishmaniasis. Rev Infect Dis 1987; 9 Suppl 1:S57.
  67. Esterre P, Inzan CK, Ramarcel ER, et al. Treatment of chromomycosis with terbinafine: preliminary results of an open pilot study. Br J Dermatol 1996; 134 Suppl 46:33.
  68. Tanuma H, Hiramatsu M, Mukai H, et al. Case report. A case of chromoblastomycosis effectively treated with terbinafine. Characteristics of chromoblastomycosis in the Kitasato region, Japan. Mycoses 2000; 43:79.
  69. Bonifaz A, Saúl A, Paredes-Solis V, et al. Treatment of chromoblastomycosis with terbinafine: experience with four cases. J Dermatolog Treat 2005; 16:47.
  70. Silva-Rocha WP, Cardoso FJ, Colalto W, et al. Clinical improvement of chromoblastomycosis refractory to itraconazole successfully treated with high dose of terbinafine. J Dermatol 2013; 40:775.
  71. Xibao Z, Changxing L, Quan L, Yuqing H. Treatment of chromoblastomycosis with terbinafine: a report of four cases. J Dermatolog Treat 2005; 16:121.
  72. Negroni R, Tobón A, Bustamante B, et al. Posaconazole treatment of refractory eumycetoma and chromoblastomycosis. Rev Inst Med Trop Sao Paulo 2005; 47:339.
  73. Tamura K, Matsuyama T, Yahagi E, et al. A case of chromomycosis treated by surgical therapy combined with preceded oral administration of terbinafine to reduce the size of the lesion. Tokai J Exp Clin Med 2012; 37:6.
  74. Castro LG, Pimentel ER, Lacaz CS. Treatment of chromomycosis by cryosurgery with liquid nitrogen: 15 years' experience. Int J Dermatol 2003; 42:408.
  75. Bonifaz A, Martínez-Soto E, Carrasco-Gerard E, Peniche J. Treatment of chromoblastomycosis with itraconazole, cryosurgery, and a combination of both. Int J Dermatol 1997; 36:542.
  76. Kullavanijaya P, Rojanavanich V. Successful treatment of chromoblastomycosis due to Fonsecaea pedrosoi by the combination of itraconazole and cryotherapy. Int J Dermatol 1995; 34:804.
  77. Ranawaka RR, Amarasinghe N, Hewage D. Chromoblastomycosis: combined treatment with pulsed itraconazole therapy and liquid nitrogen cryotherapy. Int J Dermatol 2009; 48:397.
  78. Tagami H, Ginoza M, Imaizumi S, Urano-Suehisa S. Successful treatment of chromoblastomycosis with topical heat therapy. J Am Acad Dermatol 1984; 10:615.
  79. Wu PA, Turner ML, Cowen EW, et al. Sixty-year-old man with slowly expanding nodular plaque on the thigh. J Am Acad Dermatol 2010; 63:1083.
  80. Tagami H, Ohi M, Aoshima T, et al. Topical heat therapy for cutaneous chromomycosis. Arch Dermatol 1979; 115:740.
  81. Kinbara T, Fukushiro R, Eryu Y. Chromomycosis--report of two cases successfully treated with local heat therapy. Mykosen 1982; 25:689.
  82. Hiruma M, Kawada A, Yoshida M, Kouya M. Hyperthermic treatment of chromomycosis with disposable chemical pocket warmers. Report of a successfully treated case, with a review of the literature. Mycopathologia 1993; 122:107.
  83. Tsianakas A, Pappai D, Basoglu Y, et al. Chromomycosis--successful CO2 laser vaporization. J Eur Acad Dermatol Venereol 2008; 22:1385.
  84. Hira K, Yamada H, Takahashi Y, Ogawa H. Successful treatment of chromomycosis using carbon dioxide laser associated with topical heat applications. J Eur Acad Dermatol Venereol 2002; 16:273.
  85. Yang Y, Hu Y, Zhang J, et al. A refractory case of chromoblastomycosis due to Fonsecaea monophora with improvement by photodynamic therapy. Med Mycol 2012; 50:649.
  86. Hu Y, Huang X, Lu S, et al. Photodynamic therapy combined with terbinafine against chromoblastomycosis and the effect of PDT on Fonsecaea monophora in vitro. Mycopathologia 2015; 179:103.
  87. Lyon JP, Pedroso e Silva Azevedo Cde M, Moreira LM, et al. Photodynamic antifungal therapy against chromoblastomycosis. Mycopathologia 2011; 172:293.
  88. de Sousa Mda G, Belda W Jr, Spina R, et al. Topical application of imiquimod as a treatment for chromoblastomycosis. Clin Infect Dis 2014; 58:1734.
  89. Azevedo Cde M, Marques SG, Resende MA, et al. The use of glucan as immunostimulant in the treatment of a severe case of chromoblastomycosis. Mycoses 2008; 51:341.
  90. Bayles MA. Chromomycosis. In: Bailliere’s Clinical Tropical Medicine and Communicable Diseases: Tropical Fungal Infections, Hay RJ (Ed), WB Saunders, London 1986. p.45.