Indian Dermatology Online Journal

THROUGH THE DERMOSCOPE
Year
: 2019  |  Volume : 10  |  Issue : 6  |  Page : 759--760

Dermoscopy of chromoblastomycosis


Payal Chauhan1, Rashmi Jindal1, Nadia Shirazi2,  
1 Department of Dermatology, Venereology and Leprology, Himalayan Institue of Medical Sciences, Dehradun, Uttarakhand, India
2 Department of Pathology, Venereology and Leprology, Himalayan Institue of Medical Sciences, Dehradun, Uttarakhand, India

Correspondence Address:
Payal Chauhan
Department of Dermatology, Venereology and Leprology, Himalayan Institue of Medical Sciences, Dehradun, Uttarakhand
India




How to cite this article:
Chauhan P, Jindal R, Shirazi N. Dermoscopy of chromoblastomycosis.Indian Dermatol Online J 2019;10:759-760


How to cite this URL:
Chauhan P, Jindal R, Shirazi N. Dermoscopy of chromoblastomycosis. Indian Dermatol Online J [serial online] 2019 [cited 2021 Apr 10 ];10:759-760
Available from: https://www.idoj.in/text.asp?2019/10/6/759/255533


Full Text



A 55-year-old male, farmer by occupation, resident of Garhwal region of Uttrakhand presented to us with reddish raised lesions over left arm for 5–6 years. History of trauma while working in the fields prior to development of the lesion was present. On clinical examination, single, 5 × 6 cm, ill- to well-defined erythematous plaque with overlying scales and crust along with areas of atrophy was present over dorsal aspect of left forearm [Figure 1]. Upon closer examination of the plaque, scattered tiny, black dots were seen. Dermoscopic examination (DermLite II hybrid m; 3Gen; polarized mode, ×10 magnification) revealed multiple, scattered, reddish black dots, and yellowish orange ovoid areas over a pinkish white background. Polymorphic vessels were seen surrounding these yellowish orange ovoid areas. Also seen were thick yellowish white scales and crusts [Figure 2]a and [Figure 2]b. Histopathological examination was done which showed hyperkeratotic, acanthotic epidermis exhibiting pseudoepitheliomatous hyperplasia. Well-defined epithelioid granulomas admixed with langhans giant cells, neutrophils, and plasma cells were seen in dermis. Higher power shows dark colored, 10–12 μm thick-walled sclerotic bodies were seen engulfed by the giant cell and lying freely in the dermis [Figure 3]. Mycological examination was non-contributory. Based on the clinical, dermoscopic, and histopathological correlation we reached to the diagnosis of chromoblastomycosis and the patient was started on itraconazole 200 mg twice a day.{Figure 1}{Figure 2}{Figure 3}

Chromoblastomycosis is a chronic, progressive subcutaneous mycosis caused by traumatic inoculation of dematiaceous fungi namely Fonsecaea pedrosoi, Phialophora verrucosa, Cladophialophora carrionii, and so on. The hallmark of the mycosis is presence of sclerotic bodies also known as medlar bodies which can be demonstrated by hematoxylin and eosin staining or potassium hydroxide (KOH) mount.[1] The dermoscopic findings in our case are in line with those reported earlier.[2],[3] Pink and white areas seen on dermoscopy represent the rough uneven areas of the lesion clinically. The most characteristic dermoscopic finding is the presence of multiple reddish black dots which ascribes to the process of transepidermal elimination of inflammatory cells, foreign fungal elements, and hemorrhage seen clinically as black dots.[2] The yellowish orange structures represent mycotic granulomas but are not specific to chromoblastomycosis as they can also be seen in other granulomatous disorders. The dermoscopic findings of chromoblastomycosis and its differentials have been discussed in [Table 1]. Surprisingly, on detailed literature search we could come across just a handful of case reports focussing on dermoscopy in chromoblastomycosis. Thus, we wish to highlight the dermoscopic findings of chromoblastomycosis which can act as a supplementary tool in a physician's armamentarium to clinch the diagnosis of this difficult to diagnose mycosis.{Table 1}

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.[5]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Agarwal R, Singh G, Ghosh A, Verma KK, Pandey M, Xess I, et al. Chromoblastomycosis in India: Review of 169 cases. PLoS Negl Trop Dis 2017;11:e0005534.
2Tang J, Zhuang K, Ran X, Dai Y, Ran Y. Chromoblastomycosis caused by Cladophialophora carrionii. Indian J Dermatol Venereol Leprol 2017;83:482-5.
3Subhadarshani S, Yadav D. Dermoscopy of chromoblastomycosis. Dermatol Pract Concept 2017;7:23-4.
4Dabas G, Kaur H, Vinay K, Kumaran MS, Shivaprakash MR, Saikia UN, et al. Dermoscopy in disseminated sporotrichosis. J Eur Acad Dermatol Venereol 2018. doi: 10.1111/jdv.15152. [Epub ahead of print].
5Chauhan P, Meena D, Hazarika N. Dermoscopy of sarcoidosis: A useful clue to diagnosis. Indian Dermatol Online J 2018;9:80-1.