Difficult mycoses of the skin: advances in the epidemiology and management of eumycetoma, phaeohyphomycosis and chromoblastomycosis.
OBJECTIVE
Eumycetoma, phaeohyphomycosis and chromoblastomycosis are subcutaneous mycoses having in common the fact that they are acquired as a result of penetrating trauma to the skin and may be caused by a large variety of fungi. This article will review recent data regarding the epidemiology and treatment of these infections.


RESULTS
Recent epidemiologic observations in these mycoses include an increased incidence of phaeohyphomycosis in immunosuppressed patients, the association of polymorphisms in genes involved in innate immunity, the occurrence of eumycetoma caused by Madurella mycetomatis and the nosocomial acquisition of phaeohyphomycosis. The management of these infections continues to be challenging. An approach that involves early diagnosis, the use of systemic antifungal agents and local therapies, including surgical removal of lesions, is the basis of the treatment of these diseases.


CONCLUSIONS
It is crucial that the epidemiology and clinical presentation of these infections are understood if we are to improve their outcomes.
Department of Internal Medicine, Hematology Unit and Mycology Laboratory, University Hospital, Universidade Federal do Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, Rio de Janeiro, Brazil.
Marcia
M
Garnica
Marcio
M
Nucci
Flavio
F
Queiroz-Telles
D000935:Antifungal Agents / Q000627:therapeutic use; D002862:Chromoblastomycosis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D003428:Cross Infection; D003881:Dermatomycoses / Q000188:drug therapy* / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D007113:Immunity, Innate / Q000235:genetics; D008271:Mycetoma / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D012867:Skin / Q000293:injuries / Q000382:microbiology*
D000935:Antifungal Agents