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Cutaneous involvement is frequently observed in cases of deep mycosis. In some instances, the cutaneous and/or subcutaneous signs are a consistent feature and there are no other symptoms. This will often be a primary cutaneous form caused by traumatic inoculation, which can occur with both cosmopolitan fungi (alternariosis) or those found in tropical regions (sporotrichosis, chromoblastomycosis, lobomycosis). The cutaneous signs may alternatively point to haematogenous seeding, either from a pulmonary site, as occurs in endemic mycoses following inhalation (histoplasmosis, coccidioidomycosis), or from a range of different portals of entry whether respiratory, gastrointestinal, or mucocutaneous, as seen in opportunistic mycoses caused by cosmopolitan fungi in immunodeficient patients (systemic candidiasis, cryptococcosis, aspergillosis). The main systemic mycoses are opportunistic, encouraged by underlying cellular immunodeficiency, rarely primary, and are usually acquired due to treatment with corticosteroids or another immunosuppressant in patients with the human immunodeficiency virus (HIV), a malignant blood disorder, possibly with allogeneic stem cell transplant, or in solid organ transplant. Due in particular to the widening of indications for some biological therapies, an increase in the number of severely immunocompromised patients, including those outside the populations normally at risk, is also connected to the emergence of some rare mycoses: mucormycosis, Fusarium spp., Trichosporon spp., Scedosporium spp.
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