Invasive sinusitis, sometimes with bony necrosis, as well as subcutaneous nodules or abscesses, keratitis, lung masses, osteomyelitis, mycotic arthritis, intramuscular abscess, endocarditis, brain abscess, or chronic meningitis, may occur. Diagnosis, Prognosis, and Treatment Late chromomycosis lesions have a characteristic appearance, but early involvement may be mistaken for dermatophytoses. Phaeohyphomycosis must be distinguished by histopathology and culture from the myriad other causes of facial extracutaneous infectious and noninfectious conditions. Dematiaceous fungi are frequently discernible in tissue specimens stained with conventional hematoxylin and eosin, appearing as septate, brownish bodies reflecting their natural melanin content. Masson-Fontana staining for melanin confirms their presence.
Culture is needed to identify the causative species.
Itraconazole is the most effective antifungal drug, although not all patients respond. Flucytosine is sometimes useful for ancillary therapy, because some lesions may respond rapidly but generally relapse. Fluconazole seldom causes lesions to regress, and amphotericin B is ineffective. Many cases require surgical excision for cure. All rights reserved.