Managing chromoblastomycosis with acitretin plus imiquimod: A case report on the improvement of cutaneous lesions and reduction of the treatment time

Abstract

is a mycosis that affects the skin and subcutaneous tissues. The etiologic agent is a black yeast that belongs to the Chaetothyriales order and Herpotrichiellaceae family. This fungus lives in the soil and plants of tropical and subtropical countries. In Brazil, the main etiologic agent is Fonsecaea pedrosoi, additionally infections with Exophiala jeanselmei and Exophiala spinifera have been documented. 1 The infection occurs after a contact of the lesioned skin with black yeast.Classical treatment of CBM is performed with itraconazole (200-400 mg/day), that can be associated with terbinafine (250 mg/day). These drugs are administrated for a long period of time, that basically depends on the individual response of the patient. Despite the long course of treatment, some patients do not show improvement of lesions and others exhibit signs of drug intolerance. Physical approaches, such as surgery, cryotherapy, and thermotherapy, 2 can be employed in the treatment; however, the efficacy is limited. On the other side, untreated patients display a progressive growth of the lesions, compromising the affected member. Moreover, patients presenting lesions lasting over years may develop skin carcinomas. Therefore, it is urgent to create new strategies to treat this neglected fungal disease.An interesting approach to treat infectious diseases is to combine drugs; thus, an elevated cure rate has been recorded when immunomodulatory agents were combined with drugs classically used in therapy. 3 Imiquimod, an antitumor agent, is able to stimulate the immune system through the activation of Toll-like receptors, 4 improving the immune response against infectious agents. 5,6 In fact, it has been demonstrated that patients with CBM over a

Successful management of chromoblastomycosis utilizing conventional antifungal agents and imiquimod therapy

“…Imiquimod, functioning as a Toll-like receptor agonist, has demonstrated efficacy in treating external anogenital warts, actinic keratoses, and superficial basal cell carcinomas. Studies have indicated its benefits in CBM treatment by modulating immunity and shortening the treatment course [ 9 – 19 ]. In addition, imiquimod inhibits collagen synthesis by promoting the production of the Th1 cytokine TNF-γ, and also inhibits the Th2 cellular immune response by inhibiting the production of the Th2 cytokines IL-4, IL-5, etc., ultimately controlling scar hyperplasia [ 20 , 21 ].…”

New Immunological Markers in Chromoblastomycosis—The Importance of PD-1 and PD-L1 Molecules in Human Infection

“…Among the neglected tropical diseases caused by saprophytic melanized fungi, CBM is one of the most prevalent; its etiological agents live in association with the plants that agricultural and logger workers manipulate during their work, and after an injury, they access the skin [4,27,28]. After infection, the fungi differentiate into muriform cells within phagocytes, becoming spherical and pigmented [8,29].…”

Chromoblastomycosis: New Perspective on Adjuvant Treatment with Acitretin

“…Patients treated with such combinations presented a rapid and sustainable reduction in the appearance of large verrucous plaques, which facilitated and reduced the treatment time with classic antifungals. By reducing the time of classical treatment, the risk of side effects caused by prolonged use of these medications was reduced, as well as promoting a rapid improvement in the quality of life and self-esteem of these patients [15,21,33].…”