Tinea pedis caused by Hendersonula toruloidea. A new problem in dermatology

We report the first case of tinea pedis and onychomycosis caused by Hendersonula toruloidea in the United States and, to our knowledge, the third such case reported in North America. The clinical picture is one of chronic, hyperkeratotic, recalcitrant tinea pedis similar to that caused by Trichophyton rubrum. Except for 2 years in Alaska, our 46-year-old patient had never lived outside the state of Louisiana. Previous treatment with griseofulvin and treatment with 1% bifonazole cream for 4 weeks were both ineffective. The patient did not respond to further treatment with a variety of topical antifungal preparations. This fungus is endemic to the tropical and subtropical regions; our case suggests that it may be endemic to the southern part of the United States as well. Dermatologists should be alerted to this overlooked disease entity.