The frequency of evidence of systemic involvement found in 16 cases of North American (NA) blastomycosis supports the concept that chronic cutaneous NA blastomycosis is a manifestation of the disseminated form. Blastomyces dermatitidis should be cultured to confirm the diagnosis, but treatment was undertaken after demonstration of the organism on histology or smear. The complement fixation test seemed to lack sensitivity and specificity for diagnosis. The commercially available blastomycin skin test was not helpful. Intravenous administration of amphotericin B was effective in most cases, although side effects were a problem. Oral administration of amphotericin B was ineffective in most cases. Follow-up examinations for ten years or more are recommended. Outpatient treatment with amphotericin B administered intravenously was found to be practical.
Klapman MH, Superfon NP, Solomon LM. North American Blastomycosis. Arch Dermatol. 1970;101(6):653-658. doi:10.1001/archderm.1970.04000060025006