Successful treatment of chromomycosis using carbon dioxide laser associated with topical heat applications

Abstract

A 59-year-old Japanese man presented with a slightly elevated, pruritic, erythematous plaque on his left buttock measuring 5 x 5 cm in diameter. The man had a history of chromomycosis, dating 6 years prior to the current consultation, for which he had been treated with oral terbinafine. Diagnosis of a recurrence of chromomycosis of the skin due to infection by Foncecaea pedrosoi was made after careful analysis of the clinical features, skin biopsy, KOH mounts, and fungal culture results. We administered topical heat therapy followed by treatment with CO2 laser to eradicate the unresponsive remnants of the lesion. The operative site re-epithelized within 10 weeks, and 1 year after the treatment there was no evidence of recurrence. For a recalcitrant case of chromomycosis, as in this case, the use of CO2 laser combined with topical heat therapy may be a new therapeutic modality.

Chromoblastomycosis

“…Currently, it is the only laser with very high continuous-wave power (280,281). With its high precision, minimal tissue damage, and hemostatic capacities, the carbon dioxide laser is an ideal and very useful nonselective ablative laser.…”

“…With its high precision, minimal tissue damage, and hemostatic capacities, the carbon dioxide laser is an ideal and very useful nonselective ablative laser. Lasers have been applied both as monotherapy and in combination with other treatment modalities (280)(281)(282).…”

Tropical dermatology: Fungal tropical diseases

“…Successful therapy of Fonsecaea pedrosoi infection was observed through maintenance of the surface temperature at 468C for at least 5 hours daily for 2 months and the use of a carbon dioxide laser. 113 Disabled or deformed limbs may require amputation. 95 …”

Thermotherapy in dermatologic infections

“…101,108 Infection often presents as chronic verrucous plaques that are difficult to treat and may recur after apparent cure. 109 Surgical excision with antifungal treatment may be appropriate for small lesions, whereas larger lesions may require 5-flucytosine plus oral thiabendazole, amphotericin B, or an oral triazole. 101,110 Thermotherapy is not an uncommon treatment for chromomycosis, either as monotherapy or as an adjunct to systemic antifungals in refractory cases.…”

“…[112][113][114][115][116] Moreover, thermotherapy may be used to reduce the fungal load sufficiently to allow for successful intervention via excision, systemic antifungals, or CO 2 laser ablation. 109 Given that some improvement is typically seen after 2 to 3 weeks in most successful thermotherapy-treated cases of chromomycosis, it has been advocated that thermotherapy should be tried for a few weeks before more aggressive forms of therapy are considered. 41 Tagami et al 20 revealed that F pedrosoi, the most common cause of chromomycosis, cannot grow at 42.58C, which is the likely maximum temperature that can be reached in the dermis with heat application to the skin.…”