The incubation period averages 3 weeks from the time of initial inoculation but varies from a few days to several weeks. After the fungus enters the body through a break in the skin, three types of localized infections may occur. The fixed cutaneous type is characterized by lesions restricted to the site of inoculation and may appear as a crusted ulcer or verrucous plaque. Local cutaneous-type infections also remain local but present as a subcutaneous nodule or pustule. The surrounding skin becomes erythematous and may ulcerate, resulting in a chancre. Local lymphadenitis is common. The lymphocutaneous type is the third and most common type. It is characterized by an initial painless nodule or papule at the site of inoculation that later develops subcutaneous nodules with clear skip areas along local lymphatic channels. The local reactions in all three types of infections tend to be relatively painless but show no signs of improvement without treatment.
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