Chromoblastomycosis: combined treatment with pulsed itraconazole therapy and liquid nitrogen cryotherapy

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Abstract
Background  Three patients with histology‐ and culture‐proven chromoblastomycosis reported to the Colombo South Teaching Hospital, Sri Lanka, in 2005. All three were men (age range, 48–53 years). The duration of symptoms varied from 1 to 8 years and the lesions were on the lower limbs.Methods  The patients were treated simultaneously with liquid nitrogen cryotherapy and itraconazole pulses, i.e. 200 mg twice daily for 7 days per month, 1 week on and 3 weeks off. Cryotherapy was given every fortnight using large cotton swabs attached to ekels or the cryogun.Results  Two patients showed a good clinical response within 4 months, with negative histopathology and culture in 4–6 months. The third patient was very resistant to treatment and needed a step‐up of the itraconazole dose.Conclusion  A combination of fortnightly liquid nitrogen cryotherapy and pulsed monthly itraconazole is cost‐effective and shortens the duration of therapy compared with the use of itraconazole or cryotherapy alone.

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