Cutaneous phaeohyphomycosis due to Alternaria alternata responding to itraconazole

An 81-year-old man presented with a spreading, eczematous-appearing rash on the dorsum of the right hand and forearm, originating from three small, probably post-traumatic, ulcers over the knuckles. He had the nephrotic syndrome for which he was on 60 mg prednisone daily. Histology of a biopsy of lesional skin was consistent with phaeohyphomycosis and Alternaria alternata was cultured. The rash cleared following treatment with 100 mg itraconazole daily and tapering of his prednisone dose.