Electric Heating Pad as an Adjuvant Treatment of Extensive Chromoblastomycosis in Immunocompetent Patient: A Case Report

Risa Miliawati Nurul Hidayah,1 Hendra Gunawan,1 Nisa Fauziah,2,3 Fathia Rianty1 1Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia; 2Division of Parasitology, Department of Basic Biomedical Science, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia; 3Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, West Java, IndonesiaCorrespondence: Risa Miliawati Nurul Hidayah, Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Jl. Pasteur 38, Bandung, West Java, 40161, Indonesia, Tel +628122324231 ext. 3449, Fax +62222032426, Email [email protected]: Chromoblastomycosis is a chronic fungal infection of the skin and subcutaneous tissues, caused by melanized fungi. In cases with extensive cutaneous lesions, heat therapy can be used as an adjuvant to systemic antifungal therapy. This case report aimed to demonstrate the efficacy of heat therapy using an electric heating pad as an adjuvant to itraconazole in the treatment of extensive chromoblastomycosis. A 60-year-old immunocompetent male presented with ten-year history of extensive verrucous erythematous plaques with atrophic central lesions located in the right arm. Histology and mycological examination from a direct smear and skin biopsy revealed muriform cells and pathognomonic chromoblastomycosis. Cultures grew dark-pigmented colonies, yielding Fonsecaea spp. A combination therapy of itraconazole 400 mg daily and topical heat therapy using an electric heating pad resulted in clinical improvement during the first month of treatment. Heat therapy can be administered as an adjuvant to systemic antifungal therapy because of its fungistatic and fungicidal effects, and its ability to enhance the patient’s immune response. The selection of a suitable heat therapy device is crucial for improving the success of therapy. In this case, the patient demonstrated significant improvement in cutaneous lesions after one month of combination therapy with itraconazole and heat therapy. Electric heating pads are a good choice for topical heat therapy because of their stable temperature, availability, affordability, and ease of use. Heat therapy using electric heating pads is an effective adjuvant to systemic antifungal therapy in the treatment of extensive chromoblastomycosis.Keywords: chromoblastomycosis, Fonsecaea pedrosoi, itraconazole, heat therapy