Most commonly due to Fonsecaea pedrosoi.
Can be present for years before presentation. More common in lower extremity.
Typically in barefoot workers in tropics. Starts as red plaque  enlarges and appears verrucous or warty; develop satellite lesions from scratching. Diagnosis is by KOH mounts.
If untreated  ‘cauliflower’ appearance, blocks lymphatics, oedema

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