Dermatology: Practical and Conceptual Observation | Dermatol Pract Concept 2017;7(4):6 23 DERMATOLOGY PRACTICAL & CONCEPTUAL www.derm101.com Case Presentation A 58-year-old female presented to us with a gradually progres- sive erythematous scaly plaque over dorsum of right hand for eight months. There was a single round, tender 2 x 2 cm well defined plaque, with multiple black dots, scaling and crust (Figure 1). Potassium hydroxide mount from the black dots showed multiple refractile, round, grouped coppery structures (Medlar bodies). Dermoscopy showed a reddish pink back- ground with multiple yellow-orange ovoid structures, along with interspersed brown dots, crusts and scales. Skin biopsy from the plaque showed acanthotic epidermis with mixed cell infiltrate and microabscess with pigmented spherical spores. Mycological culture from the tissue showed growth of Fonsecaea pedrosoi. Based on clinical, dermoscopic and his- topathological features, a diagnosis of chromoblastomycosis was made. Oral itraconazole 200 mg twice daily was started. Conclusion Chromoblastomycosis is a chronic fungal infection involving skin and subcutaneous tissue of the extremities. It is mostly caused by trauma [1]. Commonly isolated fungal species are Fonsecaea, Phialophora and Cladophialophora. Clinically it presents as an erythematous papule and nod- ule progressing to form a verrucous plaque with central clear- ing. Other common presentations include tumoral, cicatricial and sporotrichoid forms. Direct microscopy shows presence of 5-12 μm sized, thick-walled, dark-colored structures called Medlar bodies. Histopathology shows pseudoepithelioma- tous hyperplasia with intraepidermal abscess and Medlar bodies [2]. Isolation of the fungus on culture confirms the diagnosis of chromoblastomycosis. Treatment includes either oral itraconazole (400 mg/day) or terbinafine (500 mg/day) with or without physical modalities such as thermotherapy. Dermoscopy of chromoblastomycosis Sweta Subhadarshani1, Deepika Yadav1 1 Department of Dermatology and Venereology All India Institute of Medical Sciences, New Delhi, India Key words: chromoblastomycosis, dermoscopy Citation: Subhadarshani S, Yadav D. Dermoscopy of chromoblastomycosis. Dermatol Pract Concept 2017;7(4):23-24. DOI: https://doi. org/10.5826/dpc.0704a06 Received: June 18, 2017; Accepted: July 9, 2017; Published: October 31, 2017 Copyright: ©2017 Subhadarshani et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: None. Competing interests: The authors have no conflicts of interest to disclose. All authors have contributed significantly to this publication. Corresponding author: Sweta Subhadarshani, MD, Department of Dermatology and Venereology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi: 110049, India. Tel. 919868386876. Email: Shweta.aiims07@gmail.com Chromoblastomycosis is a chronic cutaneous fungal infection commonly caused by Fonsacea and Cladophialophora spp. Dermoscopy is a non-invasive, real-time diagnostic tool for rapid bedside di- agnosis of various inflammatory and non-inflammatory disorders and can be an excellent modality for evaluation of cutaneous mycosis, for which it shows characteristic brown dots, crust, scales and yellow orange structures. ABSTRACT mailto:Shweta.aiims07@gmail.com 24 Observation | Dermatol Pract Concept 2017;7(4):6 Dermoscopy is an excellent bedside real-time tool for the diagnosis of chromoblastomycosis. References 1. Torres-Guerrero E, Isa-Isa R, Isa M, Arenas R. Chromoblastomy- cosis. Clin Dermatol. 2012;30:403-408. 2. Uribe F, Zuluaga AI, Leon W, Restrepo A. Histopathology of chromo blastomycosis. Mycopathologia. 2013;175:477-488. 3. Arguello-Guerra L, Gatica-Torres M, Dominguez-Cherit J. Chro- momycosis. BMJ Case Rep. 2016 May 20;2016. 4. Zaias N, Rebell G. A simple and accurate diagnostic method in chromoblastomycosis. Arch Dermatol. 1973;108:545-546. 5. Tang J, Zhuang K, Ran X, Dai Y, Ran Y. Chromoblastomycosis caused by Cladophialophora carrionnii. Indian J Dermatol Vene- reol Leprol. 2017;83:482-485. Dermoscopy of chromoblastomycosis shows irregular blackish red dots and white and pink areas along with scal- ing, crusting [3]. The blackish red dots correspond to the black dots observed clinically. These represent transepithelial elimination of the inflammatory cells and fungal elements along with hemorrhage [4]. This transepithelial elimination is thought to be an important defense mechanism in restrict- ing the fungal infection. White and pink areas correspond to uneven areas [5]. Yellow, ovoid structures on dermoscopy represent granulomas. These can be seen in any granulo- matous pathology either infective or non-infective. Out of the above-mentioned dermoscopic features, the presence of irregular blackish red dots is the most useful sign in making a diagnosis of chromoblastomycosis. In fact, resolution of blackish red dots has been noted with the clinical and patho- logical clearance of the lesion [5]. Figure 1. (A) Well-defined, erythematous, scaly, crusted plaque studded with black dots (arrow) over the dorsum of the hand. (B) Dermos- copy (polarized, 16X; Heine Delta 20T, Heine Optotechnik, Herrsching, Germany) shows pink and white background with yellowish orange ovoid structures (circle), brown dots (asterisk), scale and crust. (C) Potassium hydroxide mount (400X) shows medlar bodies (arrow). [Copy- right: ©2017 Subhadarshani et al.]