Chromoblastomycosis (CBM) is a neglected human disease, caused by different species of pigmented dematiaceous fungi that cause granulomatous and suppurative dermatosis. This infection is difficult to treat and there are limited therapeutic options, including terbinafine, itraconazole, and tioconazole. Classic treatment is administered for a long period of time, but some patients do not respond properly, and therefore, such therapeutic approaches possess low cure rates. Therefore, it is vital to develop new strategies for the treatment of CBM. In this regard, it has been observed that the association of immunomodulatory molecules such as glucan with therapy carried out with antifungal drugs improves cutaneous lesions in comparison to treatment with antifungal drugs alone, suggesting that drug association may be an interesting and significant approach to incorporate into CBM therapy. Thus, the aim of this work was to associate classical antifungal therapy with the adjuvants imiquimod and acitretin. In the present case, we reported a patient with extensive CBM caused by Fonsaecae pedrosoi, that affected an extensive area of the right leg, that was left without treatment for 11 years. He was treated with a classical combination of itraconazole and terbinafine via the oral route plus topical imiquimod and oral acitretin, as an adjuvant therapy. After five months of treatment, a significant regression of verrucous plaques was observed, suggesting that the use of these adjuvants combined with the classical antifungal drugs, intraconazole plus terbinafine, can reduce treatment time and rapidly improve the patient’s quality of life. This result confirms that the use of coadjuvant drugs may be effective in the treatment of this infectious disease.

The pathogenesis of chromoblastomycosis (CBM) is associated with Th2 and/or T regulatory immune responses, while resistance is associated with a Th1 response. However, even in the presence of IFN-γ, fungi persist in the lesions, and the reason for this persistence is unknown. To clarify the factors associated with pathogenesis, this study aimed to determine the polarization of the cellular immune response and the densities of cells that express markers of exhaustion in the skin of CBM patients. In the skin of patients with CBM, a moderate inflammatory infiltrate was observed, characterized primarily by the occurrence of histiocytes. Analysis of fungal density allowed us to divide patients into groups that exhibited low and high fungal densities; however, the intensity of the inflammatory response was not related to mycotic loads. Furthermore, patients with CBM exhibited a significant increase in the number of CD4⁺ and CD8⁺ cells associated with a high density of IL-10-, IL-17-, and IFN-γ-producing cells, indicating the presence of a chronic and mixed cellular immune response, which was also independent of fungal load. A significant increase in the number of PD-1⁺ and PD-L1⁺ cells was observed, which may be associated with the maintenance of the fungus in the skin and the progression of the disease.

Tinea nigra is a chronic fungal infection of the stratum corneum caused by the fungus Hortaea werneckii, clinically manifested by asymptomatic and hyperchromic macules ranging in color from light brown to black and affecting mainly the palmar and plantar areas. must be differentiated mainly from acral melanoma. It occurs mainly in South America (Brazil, Colombia, Venezuela), Central America and the Caribbean (Panama, Cuba), Asia (India, Japan, Sri Lanka) and the coastal regions of Africa and is uncommon in Europe, correlated with travel and immigration intercontinental. In relation to Brazil in the period 1916-2020, 203 cases were reported. We present a case of palmar tinea nigra in an adult patient with 3 months of evolution, diagnosed through clinical examination, direct mycological examination, Sabouraud agar culture, and dermatoscopy of the lesion was also performed. who fully responded to topical therapy with miconazole.

Chronic infectious, granulomatous and suppurative dermatosis, classified among the subcutaneous mycoses, caused by species of pigmented dematiaceous fungi, more prevalent in tropical and subtropical regions and caused by the traumatic implantation of dematiaceous fungal species, where the presence of muriform bodies are an expression of the causal agent in the grafted tissue, characteristic of chromoblastomycosis considered the second implantation mycosis in the world, it manifests itself with slow and progressive growth lesions of exophytic and verrucous plaques and black dots on the surface. The disease is considered a neglected and occupational disease, which occurs mainly among agricultural workers, and coconut and babassu harvesters, lumberjacks and traders of agricultural products. It is important to highlight that people at risk of contracting chromoblastomycosis work in tropical countries, where the temperature can be above 40 °C in summer, and generally refuse to wear protective equipment during the day (shoes, gloves, and clothes), although they know that this type of prophylactic measure can prevent different types of diseases. These vulnerable people often live in low-income countries and sometimes live far from medical services and, once infected, do not seek medical attention. We report below an exuberant and unusual case of lower limb chromoblastomycosis with a history of 18 years of evolution. The diagnosis was established by direct mycological examination, culture and microculture that identified the agent of the Fonsecaea species, and histopathological examination.