# Deep Fungal Infections > Deep fungal infections for NEET-PG Dermatology: sporotrichosis, chromoblastomycosis, mycetoma Madura foot, sclerotic bodies, grains and itraconazole therapy. - Canonical URL: https://prepelephant.com/topics/neet-pg/dermatology/deep-fungal-infections - Exam / course: NEET-PG · Subject: Dermatology - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-02 - Last updated: 2026-10-02 - How to cite: "Deep Fungal Infections", PrepElephant, https://prepelephant.com/topics/neet-pg/dermatology/deep-fungal-infections ## Direct answer Deep (subcutaneous) mycoses are infections introduced by traumatic inoculation of saprophytic fungi into skin and subcutis, remaining localised but slowly destructive — the exam-relevant trio being sporotrichosis (Sporothrix schenckii, rose-gardener disease with lymphocutaneous nodules along lymphatics), chromoblastomycosis (dematiaceous fungi producing warty plaques with copper-penny sclerotic bodies) and mycetoma (Madura foot, a tumid, sinused swelling discharging grains, caused by either fungi or actinomycetes). Diagnosis is by potassium hydroxide mount and histopathology of the lesion plus culture; prolonged oral itraconazole (or specific agents) with surgical debridement where needed is the standard of care. ## What you must remember - Sporotrichosis: dimorphic Sporothrix schenckii enters via thorn or splinter (rose gardeners, farmers); forms a painless chancre-like nodule at the inoculation site with a chain of nodules along draining lymphatics (lymphocutaneous type, the commonest in India); fixed cutaneous type is an ulcerated or verrucous plaque; histology shows granulomas with occasional asteroid bodies (Splendore-Hoeppli phenomenon); treat with itraconazole for months (saturated potassium iodide remains a classical, inexpensive Indian option). - Chromoblastomycosis: dematiaceous (pigmented) fungi, Fonsecaea pedrosoi being the classical species, implanted by trauma in barefoot rural workers; slowly enlarging warty, cauliflower-like violaceous plaques on feet and legs; potassium hydroxide and histology show spherical, thick-walled, septate copper-penny (Medlar, sclerotic, muriform) bodies — the diagnostic clue; treat with itraconazole ± terbinafine, cryotherapy or surgery for small lesions. - Mycetoma (maduromycosis): a chronic subcutaneous infection of the foot (Madura foot) producing a painless tumid swelling with multiple sinuses discharging grains (fungal or actinomycotic colonies); eumycetoma — Madurella mycetomatis, black grains, slower course with late bone destruction; actinomycetoma — Streptomyces somaliensis, Actinomadura and Nocardia species, small pale-to-red grains, more rapid and inflammatory; diagnose grains by potassium hydroxide, histology and culture; treat actinomycetoma with cotrimoxazole-based combination therapy and eumycetoma with itraconazole plus surgical excision or amputation in advanced disease. - Rhinosporidiosis (relevant Indian entity): Rhinosporidium seeberi (now classed with mesomycetozoean protists rather than true fungi) causes friable, bleeding nasal polyps, classically in Tamil Nadu and coastal belts after bathing in stagnant ponds; sporangia packed with endospores on histology; treatment is wide surgical excision (recurrence common), with no reliable medical therapy. - Other exam-mentioned entities: lobomycosis (keloidal nodules, Central and South America) and subcutaneous zygomycosis (basidiobolomycosis, firm subcutaneous plaques of tropical children) — rare but appear as single-correct options. - Common principles: all deep mycoses need tissue diagnosis (never swabs alone), months of therapy, and surgery individualised; trauma with organic matter (thorns, wood, soil) is the shared history hook. ## Common confusion The exam contrasts grains versus sclerotic bodies: chromoblastomycosis shows copper-penny muriform cells in tissue and no grains, while mycetoma discharges grains through sinuses. Within mycetoma, eumycetoma (black grains, Madurella) must be separated from actinomycetoma (fine pale-to-red grains) because treatment differs completely — antifungals versus antibacterial combinations. The lymphocutaneous chain of sporotrichosis is mistaken for sporotricoid lesions of other infections such as nocardiosis, atypical mycobacteria (fish-tank granuloma) and cutaneous leishmaniasis — culture settles it. ## Exam-focused takeaway The high-yield hooks are occupation-and-trauma vignettes: gardener with thorn prick and nodules up the arm (sporotrichosis, asteroid bodies, itraconazole or potassium iodide), barefoot farmer with warty leg plaque and copper-penny bodies (chromoblastomycosis), and labourer with a swollen foot discharging black grains through sinuses (eumycetoma due to Madurella mycetomatis). Rhinosporidiosis and nasal polyps after pond bathing rounds off the Indian favourites. Name-the-organism and name-the-structure (grain, sclerotic body, sporangium) questions dominate. ## Frequently asked questions ### Which disease is called rose-gardener disease and why? Sporotrichosis, because Sporothrix schenckii enters through thorn pricks — classically rose thorns — producing a nodule at the site and ascending lymphocutaneous nodules. ### What are sclerotic bodies? Round, thick-walled, dark-brown, longitudinally and transversely septate cells (also called Medlar, copper-penny or muriform bodies) seen in tissue in chromoblastomycosis; their identification confirms the diagnosis. ### How do eumycetoma and actinomycetoma differ? Eumycetoma is caused by true fungi such as Madurella mycetomatis with large black grains, slower growth and late bone involvement, treated with itraconazole and surgery; actinomycetoma is caused by filamentous bacteria with small pale or red grains, more rapid inflammation and sinus formation, treated with cotrimoxazole-based antibiotic combinations. ### What is Madura foot? The classical eponym for mycetoma of the foot — a chronic, painless, tumid swelling with nodules, abscesses and multiple sinuses discharging grains, named after the Madurai region of Tamil Nadu. ### How is rhinosporidiosis diagnosed and treated? By the clinical picture of friable bleeding nasal polyps after stagnant-water exposure and histology showing sporangia packed with endospores; treatment is complete surgical excision, since medical therapy is unreliable. ### Which drugs treat sporotrichosis? Itraconazole is first line for lymphocutaneous and fixed disease; saturated solution of potassium iodide remains a classical, effective and inexpensive alternative; amphotericin is reserved for severe or disseminated disease.