Tinea unguium caused by terbinafine‐resistant Trichophyton rubrum successfully treated with fosravuconazole
Abstract
for dermatophytes: the tube method. This method involves dissolving the keratin sample completely in a micro-tube (a test tube with a small cap). The nail fragments cut out from the involved nail with clippers are put into a micro-tube, 100– 500 lL of KOH solution is added (Fig. 1a) and the tube is then capped. The sample dissolves in a matter of several hours to several days (Fig. 1b). The dissolved sample is applied to the slide glass (Fig. 1c) and the cover glass is placed (Fig. 1d). The sample can then be observed under the microscope (Fig. 1e,f). Because the cap on the tube is closed, the sample does not dry and the KOH does not crystallize. The time necessary for keratin to dissolve depends on the sample size, but 3–6 h are needed for observable dissolution. Samples dissolve completely within several days to a week, but the fungus keeps its filamentous shape. We confirmed that the fungus maintains a filiform shape after 4 weeks. The limitation of this method is the time it takes to dissolve the keratin. However, the advantage of this method is that the false-negative rate of the KOH method decreases. Because the nail is dissolved equally, microscopic observation is easy. Moreover, because storage for a long period is possible, the specimen can be observed when there is sufficient time. Of course, it is important to make an effort to first use conventional methods. However, when the sample from a nail bed is negative for dermatophytes, checking a sample from the nail…
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