Onychomycosis caused by Alternaria spp. in Tuscany, Italy from 1985 to 1999.

Cutaneous phaeohyphomycosis due to Alternaria spp. is reported with increasing frequency, especially in patients with immune deficiency. Onychomycosis caused by this mould is still rarely observed. Here we report nine cases observed in Tuscany in the period 1985-99; the agent was Alternaria alternata in eight cases and Alternaria chlamidospora in one. Diagnosis was made on the basis of repeated direct microscopic mycological examination and culture, confirmed by scanning electron microscope observation of fragments of colonies. In most cases, the clinical manifestations were dystrophy and distal subungual hyperkeratosis of one or two nails of the feet or hands. Seven cases were treated with oral itraconazole, successfully in six cases, as clinical and mycological recovery was confirmed at follow-up 1 year later.