A decade of subcutaneous mycoses in Indonesia: A systematic review

Background: Subcutaneous mycoses are chronic fungal infections that commonly affect populations in tropical regions. Indonesia, with its humid climate and large agricultural workforce, is endemic for several subcutaneous mycoses; however, national data remain fragmented and largely derived from isolated case-based reports. A consolidated synthesis is needed to better understand their clinical patterns, diagnostic challenges, and treatment outcomes.

Methods: A systematic search was performed using PubMed, Google Scholar, GARUDA, and institutional repositories for studies published from 2013 to 2025. Eligible studies included retrospective case series and case reports with clinically or histopathologically confirmed subcutaneous mycoses in Indonesia. Extracted data included demographic characteristics, clinical presentations, diagnostic methods, etiological agents, and treatment outcomes. Study selection followed PRISMA guidelines. 

Results: Seventeen publications from several Indonesian provinces were identified. Chromoblastomycosis was the most frequently reported infection, followed by eumycetoma, phaeohyphomycosis, and basidiobolomycosis. Clinical presentations were typically chronic. Chromoblastomycosis often manifested as verrucous or nodular lesions, while eumycetoma showed swelling, sinus tracts, and grains. Histopathology was the main diagnostic modality and consistently demonstrated muriform bodies or fungal grains. Culture was less frequently performed and yielded growth in few cases, with Fonsecaea pedrosoi being the predominant identified species. Itraconazole was the most commonly used antifungal and produced favorable responses, though improvement varied with lesion duration. 

Conclusion: Subcutaneous mycoses in Indonesia remain underdiagnosed and often identified at late stages. Enhanced early detection, improved diagnostic access, and broader availability of antifungal therapy are essential to reduce morbidity.