Scarring Patterns in Cutaneous Sporotrichosis: Clinical and Therapeutic Correlations

Background: Zoonotic sporotrichosis caused by Sporothrix brasiliensis has emerged as a major public health problem in Brazil, with a growing burden of cutaneous sequelae. However, scarring outcomes remain poorly characterized, particularly regarding specific morphological patterns and clinical factors that influence tissue repair. Methods: This retrospective descriptive-analytical study included patients with cutaneous sporotrichosis treated at a tertiary referral dermatology center between January 2017 and June 2024. Scars were evaluated individually according to trophism (atrophic, normotrophic, hypertrophic) and specific morphology (linear, "wax drop", or nonspecific), as well as anatomical site, clinical form, presence of inoculation chancre, orientation in relation to skin tension lines and use of cryotherapy. Statistical analyses were performed using Microsoft Excel (Microsoft Corporation, Redmond, WA, USA), with confirmatory re-analysis in Python 3 (SciPy 1.x). Results: A total of 45 patients (29 (64.4%) female; mean age 35.9 ± 23.8 years) and 202 scars were analyzed. Most scars were located on the upper limbs (162, 80.2%). Overall, 104 (51.5%) were atrophic, 91 (45.0%) hypertrophic, and 7 (3.5%) normotrophic; 43 (21.3%) showed a linear pattern and 37 (18.3%) a ‘wax drop’ pattern. At the scar level, trophism was associated with the presence of an inoculation chancre (p = 0.00026) and with a lesion axis parallel to skin tension lines (p < 0.001); the association with clinical form (p = 0.0018) was driven by the seven normotrophic scars and did not extend to hypertrophic scarring (p = 0.67). Thirty-eight scars (18.8%), arising from six patients, were treated with cryotherapy: atrophic scars were proportionally more frequent at the scar level (28 (73.7%) vs. 76 (46.3%); p = 0.0076), but this was not confirmed with the patient as the unit of analysis (59.4% vs. 45.2%; p = 0.45), nor was treatment duration shorter (30.8 vs. 18.8 weeks; p = 0.27). Because scars were unevenly clustered within patients, scar-level p-values are descriptive. Conclusions: Cutaneous sporotrichosis is associated with a substantial scar burden, frequently with distinctive linear and ‘wax drop’ patterns; the linear arrangement on the upper limbs may be mistaken for self-inflicted injury and is the most directly actionable observation of this series. The presence of an inoculation chancre and a lesion axis parallel to skin tension lines were associated with hypertrophic scarring at the scar level, whereas differences associated with cryotherapy were not confirmed at the patient level and should not be interpreted as evidence of a therapeutic effect. Prospective studies with clustering-adjusted analyses are needed to validate these observations.