[8][9] While the species is only found at low abundance in nature, metabolically active strains are commonly isolated in saunas, steam baths, and dish washers.
[14] In 2002, an outbreak of systemic E. dermatitidis infection occurred in women who had received contaminated steroid injections at North Carolina hospitals.
[8] However, the occurrence of two mating type idiomorphs in approximately equal numbers among clinical and environmental isolates suggests that E. dermatitidis reproduces sexually.
[24] It is thought that extracellular polysaccharides may protect the species from stress in hot and moist environments, as this feature is typical of strains isolated from steam baths.
[9] Studies suggest that colonies of E. dermatitidis and related fungi growing within the ruins of the Chernobyl Nuclear Power Plant may be able to metabolize ionizing radiation.
[25] Exophiala dermatitidis has been isolated around the world in low abundance from a variety of environmental sources, including soil, decaying timber, and wasp nests.
[9][13][21] The thermophilicity and acid tolerance of E. dermatitidis suggests passage through warm-blooded animals, and it is hypothesized that its ecological niche might be associated with tropical, frugivorous bird and bat species.
[14][26] An ability to utilize nutrients in diverse environments, to adhere to fruit surfaces, and progress through different morphological phases are considered to provide further evidence for this theory.
[14] While E. dermatitidis has been found only in low abundance in nature, the species is well suited to survive in a number of warm and wet man made niches.
[19][29] The high fatality rate is primarily due to an ability to form systemic and neurotropic infections, which represent approximately half of reported E. dermatitidis cases.
[11][12][21] Conditions that might predispose people towards an invasive opportunistic infection include diabetes mellitus, lymphocytic leukemia, bronchiectasis, rheumatoid arthritis, and catheterization.
[29] Central nervous system phaeohyphomycosis is rare, and for unknown reasons primarily arise in East Asia, despite a cosmopolitan distribution of the fungus.
[32] Exophiala dermatitidis occurs at very high frequency in both Asian and European saunas, and absence of neurotrophic mycosis in Europe isn't explained by reduced exposure to the fungus.
[24] In 2002 a small outbreak of systemic E. dermatitidis infection occurred in North Carolina hospitals, involving five women who received steroid injections for pain management.
[16] The outbreak was traced back to a single compounding pharmacy, which was found by the FDA to have inadequately controlled for sterility of its products.
[21] As with other black yeasts that cause phaeohyphomycosis, melanin appears to have defensive purpose, and helps protect E. dermatitidis from death within human neutrophils.