Is it worth to treat a cultured Exophiala dermatitidis on only one single fingernail since it is an opportunistic yeast notoriously resistant to antifungal drugs?
More than a year ago a 49-year-old patient received chemotherapy because of breast cancer. During and after the treatment the distal parts of most nails became yellowish. After a while the change disappeared spontaneously, persisting only on the middle finger of the left hand. Beside Exophiala dermatitidis the culture was also positive for Candida parapsilosis.
The antibiogram showed a resistence of E. dermatitis to itraconazole, and a sensitivity of C. parapsilosis to fluconazole, and a dose dependent sensitivity to itraconazole.
If yes, what would be the best treatment option?
Dear Dr.Marko,
You mentioned that fingernail culture yielded Exophiala dermatitidis and Candida parapsilosis but you did not mention the result of direct microscopy of affected nail. I , therefore, suggest you to please do the direct microscopy of nail clipping in potassium hydroxide solution to demonstrate the fungal elements. If direct microscopy is positive, you perform the drug sensitivity with Fluconazole, Posaconazole and Voriconazole. If both the fungi are sensitive, it is advisable to treat the patient with any of the broad spectrum antifungal drug. Since your patient is on chemotherapy, it is pertinent to monitor the treatment.In case of any side effects, the treatment should be discontinued and the physician should be consulted.
We have treated with patients of onycomycosis due to Aspergillus flavus, A.fumigatus, and A.niger with topical application of 2% solution of tincture iodine two times daily on the affected nails for 15 to 30 days depending on the severity of cases.
With best wishes,
Prof.Dr.Mahendra Pal
Dear Dr.Marko,
Many thanks to recommend my answer. We are working in the field of Medical Mycology and Veterinary Public Health since 1973. We have published over 610 papers and authored 9 books.We have also developed two cultural media ( Pal sunflower seed medium, APRM agar) and two stains ( PHOL stain ,Narayan stain) for the study of fungi, which are implicated in the etiology of various clinical disorders in humans and animals. If you wish, you may please download our papers from Research Gate.
Please do not hesitate to contact me for any advice. I will be glad to help you.
With kind regards,
Prof.Dr.Mahendra Pal
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