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

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.

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.

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.

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.