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Bassas-Vila, M.J. Fuente, R. Guinovart, C. Ferrándiz" "autores" => array:4 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Bassas-Vila" "email" => array:1 [ 0 => "julibassas@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "M.J." "apellidos" => "Fuente" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Guinovart" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Ferrándiz" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servei de Dermatologia, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Cromomicosis. Respuesta al tratamiento combinado con crioterapia y terbinafina" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 650 "Ancho" => 976 "Tamanyo" => 81953 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Firm contiguous plaques with crusted areas on a erythematous base and a larger area with a scar-like appearance.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">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 <span class="elsevierStyleItalic">Fonsecaea pedrosoi</span>, followed by <span class="elsevierStyleItalic">Phialophora verrucosa</span> and <span class="elsevierStyleItalic">Cladophialophora carrionii</span>.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> 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.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> 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.</p><p id="par0010" class="elsevierStylePara elsevierViewall">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.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Physical examination revealed indurated, erythematous, contiguous plaques with warty, crusted areas; adjacent to these plaques was a larger whitish area with a scar-like appearance (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The regional lymph nodes were not palpable.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Laboratory tests, including a complete blood count with white blood cell count, basic biochemical tests, liver function tests, and coagulation tests, showed no abnormalities. The erythrocyte sedimentation rate was normal. Histology showed pseudoepitheliomatous epidermal hyperplasia and an intense inflammatory granulomatous reaction throughout the dermis with epithelioid cells, giant multinucleated cells, plasma cells, neutrophils, and occasional microabscesses. The dermis and microabscesses contained small (5-15<span class="elsevierStyleHsp" style=""></span>μm) pigmented spores with a thick wall and in some cases central septation (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Periodic-acid Schiff and methenamine silver stains were positive.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Bacterial and fungal cultures of biopsy specimens yielded several colonies of <span class="elsevierStyleItalic">Stenotrophomonas maltophilia</span> and <span class="elsevierStyleItalic">F pedrosoi</span>, respectively. The mycobacterial culture was negative.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Based on the above results, we established a definitive diagnosis of cutaneous chromoblastomycosis. Topical antibiotics were administered to treat the secondary bacterial infection and the lesions were treated by curettage. The patient was also prescribed terbinafine (500<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h) and 1 month later underwent the first of 2 cryotherapy sessions separated by an interval of 2 months. Treatment with terbinafine was maintained for 6 months, with a progressive reduction in doses. The lesions healed, leaving residual scarring (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>), and no recurrences were observed during the 24-month follow-up period.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Chromoblastomycosis is difficult to treat because of differences in antifungal sensitivity patterns and responses among the species isolated and also because of the refractory nature of the condition, particularly in more serious clinical forms.The different treatment modalities available have not been compared in clinical settings. Recurrence is common, hence the recommendation for long-term treatments, lasting between 3 and 18 months, depending on the study.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Possible complications include secondary bacterial infection with lymphadenitis and, less frequently, the development of squamous carcinoma in lesions that have been present for a very long time.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In our case, the only complication was secondary impetiginization, which was resolved with topical antibiotics.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Treatments can be divided into 3 broad modalities: physical treatments,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> pharmacologic treatments, and combined therapies. Surgery may be the best choice in the early stages of disease, but systemic antifungals are necessary in more advanced cases.</p><p id="par0045" class="elsevierStylePara elsevierViewall">A variety of treatment regimens have been attempted, but it is impossible to determine the best option due to a lack of comparative clinical studies using objective criteria. The best systemic antifungals seem to be itraconazole and terbinafine because of their spectrum of action and safety in long-term regimens. However, tissue fibrosis secondary to infection can reduce drug tissue levels. Terbinafine may have antifibrotic properties that would favor the healing of chromoblastomycosis lesions.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Terbinafine combined with cryotherapy has emerged as a possible treatment option in recent years. Of all the physical treatments described in the literature, cryotherapy is associated with the best outcomes, with a cure rate of 40.9% when used as monotherapy.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Moreover, it appears to be particularly useful when combined with systemic antifungals to treat long-standing lesions that are not candidates for surgery. In such cases the antifungal treatment should be administered a month before cryotherapy to prevent the spread of infection described in patients treated with cryotherapy alone.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,10</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In our patient, 2 cycles of cryotherapy combined with oral terbinafine for 6 months achieved cure and caused minimal local adverse effects (hyperpigmentation and mild residual fibrosis). Recent publications confirm that combined therapies offer better results in patients with chronic chromoblastomycosis that is not amenable to surgical treatment.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Bassas-Vila J, Fuente M, Guinovart R, Ferrándiz C. Cromomicosis. Respuesta al tratamiento combinado con crioterapia y terbinafina. Actas Dermosifiliogr. 2014;105:196–198.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 650 "Ancho" => 976 "Tamanyo" => 81953 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Firm contiguous plaques with crusted areas on a erythematous base and a larger area with a scar-like appearance.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 650 "Ancho" => 864 "Tamanyo" => 214811 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Pseudoepitheliomatous hyperplasia and presence of pigmented spores (copper pennies or Medlar or sclerotic bodies) measuring 6-12 <span class="elsevierStyleHsp" style=""></span>μm (hematoxylin-eosin, original magnification ×100).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 650 "Ancho" => 866 "Tamanyo" => 102537 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Residual scar-like lesions.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chromoblastomycosis: Clinical presentation and management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M. 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Year/Month | Html | Total | |
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2024 October | 92 | 46 | 138 |
2024 September | 104 | 24 | 128 |
2024 August | 126 | 68 | 194 |
2024 July | 91 | 34 | 125 |
2024 June | 113 | 35 | 148 |
2024 May | 103 | 41 | 144 |
2024 April | 88 | 16 | 104 |
2024 March | 81 | 32 | 113 |
2024 February | 86 | 36 | 122 |
2024 January | 65 | 33 | 98 |
2023 December | 61 | 20 | 81 |
2023 November | 60 | 21 | 81 |
2023 October | 82 | 25 | 107 |
2023 September | 71 | 26 | 97 |
2023 August | 41 | 15 | 56 |
2023 July | 74 | 35 | 109 |
2023 June | 70 | 32 | 102 |
2023 May | 97 | 21 | 118 |
2023 April | 61 | 21 | 82 |
2023 March | 42 | 21 | 63 |
2023 February | 73 | 19 | 92 |
2023 January | 43 | 35 | 78 |
2022 December | 62 | 53 | 115 |
2022 November | 33 | 30 | 63 |
2022 October | 29 | 16 | 45 |
2022 September | 27 | 44 | 71 |
2022 August | 29 | 42 | 71 |
2022 July | 34 | 34 | 68 |
2022 June | 25 | 35 | 60 |
2022 May | 54 | 41 | 95 |
2022 April | 57 | 35 | 92 |
2022 March | 43 | 62 | 105 |
2022 February | 45 | 39 | 84 |
2022 January | 52 | 41 | 93 |
2021 December | 48 | 41 | 89 |
2021 November | 47 | 46 | 93 |
2021 October | 60 | 42 | 102 |
2021 September | 49 | 42 | 91 |
2021 August | 33 | 34 | 67 |
2021 July | 35 | 27 | 62 |
2021 June | 53 | 29 | 82 |
2021 May | 34 | 35 | 69 |
2021 April | 73 | 45 | 118 |
2021 March | 93 | 20 | 113 |
2021 February | 56 | 28 | 84 |
2021 January | 40 | 12 | 52 |
2020 December | 36 | 8 | 44 |
2020 November | 25 | 18 | 43 |
2020 October | 24 | 8 | 32 |
2020 September | 32 | 11 | 43 |
2020 August | 26 | 11 | 37 |
2020 July | 31 | 15 | 46 |
2020 June | 34 | 25 | 59 |
2020 May | 26 | 18 | 44 |
2020 April | 31 | 18 | 49 |
2020 March | 34 | 26 | 60 |
2020 February | 3 | 6 | 9 |
2020 January | 6 | 0 | 6 |
2019 December | 8 | 7 | 15 |
2019 November | 4 | 2 | 6 |
2019 September | 6 | 6 | 12 |
2019 August | 4 | 3 | 7 |
2019 July | 4 | 14 | 18 |
2019 June | 4 | 18 | 22 |
2019 May | 6 | 31 | 37 |
2019 April | 5 | 8 | 13 |
2019 March | 4 | 3 | 7 |
2019 February | 1 | 4 | 5 |
2019 January | 3 | 0 | 3 |
2018 December | 2 | 2 | 4 |
2018 November | 3 | 2 | 5 |
2018 October | 4 | 1 | 5 |
2018 September | 3 | 0 | 3 |
2018 July | 0 | 1 | 1 |
2018 May | 0 | 6 | 6 |
2018 April | 0 | 5 | 5 |
2018 February | 64 | 2 | 66 |
2018 January | 37 | 4 | 41 |
2017 December | 75 | 5 | 80 |
2017 November | 38 | 10 | 48 |
2017 October | 28 | 2 | 30 |
2017 September | 38 | 9 | 47 |
2017 August | 53 | 6 | 59 |
2017 July | 46 | 9 | 55 |
2017 June | 55 | 13 | 68 |
2017 May | 50 | 13 | 63 |
2017 April | 58 | 16 | 74 |
2017 March | 35 | 23 | 58 |
2017 February | 35 | 7 | 42 |
2017 January | 20 | 8 | 28 |
2016 December | 36 | 7 | 43 |
2016 November | 53 | 7 | 60 |
2016 October | 60 | 8 | 68 |
2016 September | 70 | 13 | 83 |
2016 August | 51 | 7 | 58 |
2016 July | 39 | 12 | 51 |
2016 June | 9 | 7 | 16 |
2016 May | 3 | 8 | 11 |
2016 April | 5 | 5 | 10 |
2016 March | 8 | 2 | 10 |
2016 February | 11 | 4 | 15 |
2016 January | 5 | 10 | 15 |
2015 December | 13 | 10 | 23 |
2015 November | 13 | 9 | 22 |
2015 October | 9 | 1 | 10 |
2015 September | 8 | 1 | 9 |
2015 August | 11 | 2 | 13 |
2015 July | 52 | 12 | 64 |
2015 June | 31 | 5 | 36 |
2015 May | 47 | 6 | 53 |
2015 April | 33 | 4 | 37 |
2015 March | 23 | 2 | 25 |
2015 February | 19 | 2 | 21 |
2015 January | 24 | 4 | 28 |
2014 December | 21 | 3 | 24 |
2014 November | 23 | 6 | 29 |
2014 October | 20 | 7 | 27 |
2014 September | 25 | 6 | 31 |
2014 August | 16 | 6 | 22 |
2014 July | 10 | 8 | 18 |
2014 June | 22 | 7 | 29 |
2014 May | 31 | 12 | 43 |
2014 April | 25 | 9 | 34 |
2014 March | 18 | 11 | 29 |