The treatment of chromoblastomycosis is complex. I have not found controlled clinical studies of therapy. It is not clear though whether a single drug can cure extensive disease. Most of the treatment failures appear to occur where the infection covers a wide area.
The main treatments currently in use are itraconazole and terbinafine. Itraconazole has been used in doses of 100-200 mg daily with good results, particularly in early cases.25 Terbinafine has been used in doses of 250 mg daily, also with good responses.26,27 There is less experience with fluconazole, although it has been cited as an effective therapy.28 There is no clear evidence that there are different responses to the two agents. In unresponsive cases, alternatives include combination therapy with amphotericin B and flucytosine,29 or itraconazole and flucytosine.30 Physical methods such as heat therapy and cryotherapy have also been used. Heat therapy involves application of heat-retaining materials to the lesions, repeated daily or less frequently over a number of weeks.31 Itraconazole has also been used in a pulsed format32 and in combination with other agents such as shaving, cryotherapy and 5-flucytosine.33 One comparative trial of 12 patients with histologically confirmed chromoblastomycosis evaluated the benefit of cryotherapy in addition to itraconazole.34 The authors suggested that itraconazole can be used initially to reduce the size of lesions, with cryotherapy being given to the residual lesion.
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