The present paper describes 22 cases of chromoblastomycosis (CBM) caused by Cladophialophora carrionii in children and adolescents (2-19 years old). The patients were seen between 1992 and 2004 and all resided in a CBM endemic area in the semi-arid zone of the Falcón state, Venezuela. Twelve of the 22 patients (54.55%) had close relatives who also had CBM and 19 (86.36%) were male. Lesions consisted of erythematous papules with desquamation or squamous plaques (0.12-14.19 cm in diameter), located primarily on the upper limbs (77.27% of patients). Thirteen of the patients were treated with topical 5-fluorouracil (5-FU; 1% cream), seven with topical ajoene (0.5% gel) and two had electrodesiccation and/or fulguration. Two patients who did not respond to 5-FU were treated with oral itraconazole (100 mg/day for 1 month). Complete clinical and mycological remission was achieved in 17/20 (85%) of the patients treated with 5-FC, ajoene and electrodesiccation and/or fulguration. In addition, similar results were obtained with the two patients who received itraconazole therapy. These cases emphasize the importance of early diagnosis in difficult-to-treat mycotic diseases such as CBM. By early intervention we were able to employ topical treatment with a minimum of adverse effects to achieve a high percentage of favorable therapeutic responses. The patients were thus able to avoid the evolution of the chronic, deforming and incapacitation clinical manifestations associated with CBM.
Ajoene and 5-fluorouracil (5-FU) are compounds that have shown in-vitro activity against Cladophialophora carrionii, an important etiologic agent of chromoblastomycosis. An open comparative trial was conducted to assess safety and effectiveness of topical ajoene and 5-FU in the treatment of localized chromoblastomycosis. Thirty-seven patients with a clinically and mycologically confirmed diagnosis were randomly distributed into two groups allocated to ajoene (0.5% gel; n = 19) or 5-FU (1% cream; n = 18). Topical treatment was applied to localized lesions (< or = 2.5-cm diameter) once a day, with occlusion, for 12-16 weeks. Complete clinical and mycological remission was achieved in 14/19 patients (74%) treated with ajoene and 14/18 patients (78%) treated with 5-FU. All 5-FU-treated patients developed a post-treatment scar at the site of the lesion, while ajoene-treated patients showed only a slight depigmentation of the skin. The differences observed in cure rate between ajoene and 5-FU are not statistically significant. Follow-up of all patients for 4 years revealed no relapses in the ajoene-treated group, while one patient in the 5-FU-treated group had a relapse 6 months after the end of therapy. This trial represents the first clinical use of ajoene in the control of a deep mycosis.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.