This 50-year-old man developed a slowly progressive scaly pink to violaceous plaque on his left forearm 10 years earlier. He had a long history of taking oral prednisone for pemphigus folicaeous. The lesion failed to improve with topical treatment and oral antibiotics. A skin biopsy revealed the typical picture of chromoblastomycosis, with "coffee grains" (round, thick-walled, brown cells called sclerotic bodies or medlar bodoes) and a chronic granulomatous infiltrate. The patient was
treated with liquid nitrogen application, but the plaque recurred. The plaque was then excised, and there was no evidence of recurrence at followup examonation 1 month later. Although he did not remember traumatizing the area on his forearm, he worked outdoors in the countryside.
6 cm annular violaceous plaque with overlying scaly and dyspigmentation at the border