Photodynamic Therapy Combined with Terbinafine Against Chromoblastomycosis and the Effect of PDT on Fonsecaea monophora In Vitro

Abstract

Chromoblastomycosis, a chronic fungal infection of skin and subcutaneous tissue caused by dematiaceous fungi, is associated with low cure and high relapse rates. Among all factors affecting clinical outcome, etiological agents have an important position. In southern China, Fonsecaea pedrosoi and Fonsecaea monophora are main causative agents causing Chromoblastomycosis. We treated one case of chromoblastomycosis by photodynamic therapy (PDT) of 5-aminolevulinic acid (ALA) irradiation combined with terbinafine 250 mg a day. The lesions were improved after two sessions of ALA-PDT treatment, each including nine times, at an interval of 1 week, combined with terbinafine 250 mg/day oral, and clinical improvement could be observed. In the following study, based on the clinical treatment, the effect of PDT and antifungal drugs on this isolate was detected in vitro. It showed sensitivity to terbinafine, itraconazole or voriconazole, and PDT inhibited the growth. Both the clinic and experiments in vitro confirm the good outcome of ALA-PDT applied in the inhibition of F. monophora. It demonstrated that combination of antifungal drugs with ALA-PDT arises as a promising alternative method for the treatment of these refractory cases of chromoblastomycosis.

Chromoblastomycosis

“…Also, combination therapy with antifungals and PDT has been reported. Hu et al combined oral terbinafine treatment with weekly 5-aminolevulinic acid (ALA)-PDT in a case of CBM; apparent clinical improvement was achieved within less than a year, and no recurrence was observed (286). PDT is minimally invasive, with few side effects, and may shorten the time of treatment.…”

Chromoblastomycosis: an etiological, epidemiological, clinical, diagnostic, and treatment update

“… 105 , 106 Hu et al used oral terbinafine in combination with photodynamic therapy with 5-aminolevulinic acid in a case of CBM, with apparent clinical improvement in less than a year and no recurrence. 107 Mohs micrographic surgery has been used to treat a variety of skin neoplasms with excellent results. The technique was used successfully to treat a localized cutaneous CMB lesion, with no recurrence of the lesion after a year of follow-up.…”

Successful treatment of chromoblastomycosis of 10‐year duration due to Fonsecaea nubica

“…Carbon dioxide laser is an ideal and very useful laser to treat chromoblastomycosis, with its high precision, minimal tissue damage and haemostatic capacities . As a promising treatment option for a better quality of life for patients, photodynamic therapy is minimally invasive and may shorten the time of treatment, and its side effects are mild, such as burning sensation, stinging or pain . Thermotherapy was applied in this study and it is very useful and economic for low‐income patients .…”

“…22,23 As a promising treatment option for a better quality of life for patients, photodynamic therapy is minimally invasive and may shorten the time of treatment, and its side effects are mild, such as burning sensation, stinging or pain. 24,25 Thermotherapy was applied in this study and it is very useful and economic for low-income patients. 26 The maximum growth temperature of aetiological agent of chromoblastomycosis is 42-46°C.…”