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PubMed This is a summary of 21 peer-reviewed journal articles Updated
Dermatology · Chromoblastomycosis

Signs and Symptoms of Chromoblastomycosis

At a Glance

Chromoblastomycosis is a slow-growing fungal skin infection that often starts as a painless bump or discolored patch, usually on the feet or legs. Over years, lesions may become warty, thick, painful, itchy, swollen, or draining.

Because it grows so slowly—often over decades—the way chromoblastomycosis looks can change significantly as the infection matures [1][2]. Understanding the different “faces” of this condition can help you describe your symptoms more accurately to your care team and monitor how the infection is progressing.

The Beginning: A Quiet Start

The infection usually begins as a small, painless, reddish bump called a papule or a flat, discolored patch called a macule [3][4]. Because these early signs don’t hurt and grow very slowly, they are often dismissed as a common wart or a minor insect bite. Over months or years, the fungus expands deep within the skin, leading to more distinct shapes and textures.

The Five Main Lesion Subtypes

Dermatologists generally classify chromoblastomycosis into five physical forms. It is common for one person to have more than one of these types at the same time [5][6].

  1. Nodular: These are raised, firm, rounded bumps. They are often the first stage of the infection and can eventually merge or transform into other types [5][7].
  2. Verrucous (Wart-like): This is the most common form [1]. These lesions have a rough, dry, crusty surface and may look like a cauliflower. They often have tiny black dots on the surface, which are actually the fungus being pushed out of the skin [8][9].
  3. Tumorous (Exophytic): These are large, protruding masses that look like tumors. They grow outward from the skin and can become quite bulky [6][1].
  4. Plaque-like: These are flat, raised areas of skin with distinct edges. They may be scaly or slightly bumpy and can cover large areas of a limb [6][10].
  5. Cicatricial (Scarring): These lesions look like expanding scars. They often have a “creeping” appearance, where the center is flat and pale (atrophic), while the outer edges remain active and reddish as the infection moves into healthy skin [11][12].

Where It Appears and How It Spreads

Most lesions (60% to 80% in some studies) occur on the lower extremities, particularly the feet and legs, because these areas are most likely to come into contact with soil and thorns [1][13]. However, it can also appear on the arms, hands, and trunk [14].

The fungus usually stays in one localized area, but new bumps can sometimes appear nearby. This localized spread usually happens in two ways:

  • Local Extension: The infection simply grows slowly outward into surrounding tissue.
  • Autoinoculation: Accidentally scratching the fungus from an active lesion into a nearby scratch or cut.
  • Lymphatic Spread (Uncommon): Rarely, the fungus may travel through the lymphatic system (the body’s drainage network), causing new “satellite” lesions to appear further up the limb [15][16].

Day-to-Day Symptoms

While the lesions themselves may not be painful at first, the chronic nature of the infection eventually causes noticeable symptoms:

  • Itching and Burning: Many patients report persistent itching, which can lead to scratching and secondary infections [1][17].
  • Pain and Tenderness: As lesions grow larger or become “tumorous,” they can become painful, especially if they are located in areas that rub against clothing or shoes [17].
  • Swelling (Lymphedema): The chronic inflammation can damage your lymph vessels over time. This leads to lymphedema, a type of firm swelling in the limb that can make the area feel heavy and difficult to move [18][19].
  • Odor and Drainage: If the lesion becomes ulcerated or develops a secondary bacterial infection, it may produce a foul-smelling discharge or pus [20][21].

The journey of chromoblastomycosis is measured in years, not weeks. Because it progresses so slowly, it is important to pay attention to even subtle changes in the texture, size, or sensation of your skin [1].

Common questions in this guide

What are the first signs of chromoblastomycosis?
It often begins as a small, painless reddish bump or a flat discolored patch on the skin. Because it changes slowly, it may be mistaken for a wart or insect bite, but it can enlarge and change texture over months or years.
What can chromoblastomycosis lesions look like?
Lesions may be nodular, rough and wart-like, outward-growing and bulky, flat and plaque-like, or scar-like with an active red edge. A person can have more than one pattern at the same time.
Where does chromoblastomycosis usually appear, and how can it spread?
It most often affects the feet and legs, although the arms, hands, and trunk can also be involved. It usually spreads slowly into nearby skin, can be moved to a nearby cut by scratching, and rarely travels through lymph vessels to form satellite lesions.
What symptoms can develop as chromoblastomycosis progresses?
Itching and burning are common, and larger lesions may become painful or tender. Long-term inflammation can cause firm limb swelling called lymphedema, while ulceration or a secondary bacterial infection may cause foul-smelling drainage or pus.
How quickly does chromoblastomycosis change?
Chromoblastomycosis usually progresses very slowly over years or even decades rather than weeks. Changes in a lesion’s size, texture, color, sensation, swelling, or drainage should be discussed with a healthcare professional.

Questions For You

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Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Which of the five clinical subtypes (nodular, verrucous, tumorous, plaque, or cicatricial) do my lesions most closely resemble?
  2. 2.Given that I have multiple lesions, do you think they spread through local extension or through direct contact (autoinoculation)?
  3. 3.Is the swelling in my limb a sign of early lymphedema, and how should we manage that alongside the fungal treatment?
  4. 4.Do you see any signs of a secondary bacterial infection that needs to be evaluated for antibiotics?
  5. 5.How often should we monitor these lesions for any changes that might suggest malignant transformation into skin cancer?

References

References (21)
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    Chromoblastomycosis in the Amazon region, Brazil, caused by Fonsecaea pedrosoi, Fonsecaea nubica, and Rhinocladiella similis: Clinicopathology, susceptibility, and molecular identification.

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This page is for informational purposes only and does not constitute medical advice. A dermatologist or other qualified clinician should evaluate persistent, changing, draining, or swollen skin lesions.