The American variety of piedra (black piedra) affects mainly women and infests only the scalp. The European form (white piedra) infests the beard and moustache. Piedra is not highly contagious; infection may occur through using a towel, hat, or comb used by an infected person.
How to distinguish black piedra from white piedra?
What causes black pidra on scalp?
What is a piedra?
What is the name of the infection that affects both sexes and all ages?
What is a differential diagnosis of lice?
What does white piedra do to hair?
What is a clinical presentation of a hair shaft infection?
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Is piedra contagious?
The natural habitats of Trichosporon species are soil, lake water, and plants, and such fungi are occasionally seen as normal flora of the human skin and mouth. White piedra is not considered contagious; instead, it is probably acquired from the environment by susceptible individuals under appropriate conditions.
How common is black piedra?
Black piedra is another infection of the hair shafts that is caused by a black yeast,Piedraia hortae. The disease is rare and confined mainly to parts of the humid tropics. The infection manifests as small black nodules on the hairs of the scalp and less commonly elsewhere.
How did I get piedra?
The technical cause of white piedra is a fungus of the trichosporon variety. This fungus is found mostly in soil. It is not clear how people get this infection but it may be that people who get white piedra already have the trichosporon fungus on their skin.
How do you cure black piedra?
Black piedra is treated by using oral terbinafine. White piedra can be treated by using topical antifungals, including imidazoles, ciclopirox olamine, 2% selenium sulfide, 6% precipitated sulfur in petroleum, chlorhexidine solution, Castellani paint, zinc pyrithione, and amphotericin B lotion.
How is black piedra spread?
The soil appears to be the primary source of infection in black piedra, although P. hortae, has also been traced in stagnant water and crops. P. hortae can produce sexual spores in the parasitic phase, which is a unique feature of this fungus among other pathogenic fungi.
Is black piedra chronic?
They are composed of a compact cellular substance that surrounds the hair shaft. Hair shafts affected by these nodules become weak and often break at the point of infection. Black piedra is chronic and can last for months or even years.
How common is piedra?
The nodules may feel gritty and cause the hair to weaken and break. White piedra is rare and most often affects young women who live in temperate and tropical climates.
How is black piedra diagnosed?
Black piedra results in the formation of firm nodules along the shaft of the hair. The diagnosis of piedra may be made easily by observation of hyphae on affected hair. Clipping of the affected hair is usually the most effective treatment modality, followed by application of topical antifungals or keratolytics.
Is piedra itchy?
These are soft and loosely clump together on your hair. You'll find white Piedra on scalp hair, facial hair, and body hair. This is usually associated with brittle hair, stinging pain, and itching.
Why is there black ball in my hair?
The black dots are due to remnant of the upper part of the hair root, which remains adherent to the hair-follicle ostium. Hair powder, also known as hair dust, on the other hand, is caused by complete destruction of the hair shaft, leaving a 'sprinkled hair residue' [1].
What is the black stuff in my hair follicles?
Black dots correspond to remnants of hair shafts in the follicular ostia and cannot be removed mechanically. They are usually associated with other forms of broken hairs. The second trichoscopic finding is hair dye; if hair is improperly washed, dye can deposit on the scalp and may even penetrate the follicular ostia.
What is the difference between black piedra and white piedra?
The two types of piedra, white piedra and black piedra are caused by fungi of the genera Trichosporon and Piedraia respectively. [1,2] Typically, black piedra affects the scalp hair, while white piedra tends to affect facial, axillary and pubic hair.
How common is piedra?
The nodules may feel gritty and cause the hair to weaken and break. White piedra is rare and most often affects young women who live in temperate and tropical climates.
How common is black fungus?
Black Fungus or mucormycosis is a rare but dangerous invasive fungal infection caused by a group of molds called mucormycetes. Black fungus commonly affects the sinuses and lungs but can affect skin and brain. People can get infected when they inhale the mold spores or touch the mold spore.
How is black piedra diagnosed?
Black piedra results in the formation of firm nodules along the shaft of the hair. The diagnosis of piedra may be made easily by observation of hyphae on affected hair. Clipping of the affected hair is usually the most effective treatment modality, followed by application of topical antifungals or keratolytics.
Why is there black ball in my hair?
The black dots are due to remnant of the upper part of the hair root, which remains adherent to the hair-follicle ostium. Hair powder, also known as hair dust, on the other hand, is caused by complete destruction of the hair shaft, leaving a 'sprinkled hair residue' [1].
Piedra Medication: Antifungal agents, Dermatologic agents
Treatment of white piedra can be a therapeutic challenge. Several topical and systemic antifungal agents may not eradicate the disorder. However, they should be tried, as scalp and hair infection may sometimes be successfully treated with a combination of oral azole antifungals and shampoos without shaving the scalp.
What is black piedra?
Introduction. Black piedra is a fungal infection of the hair shafts. It is also known as Trichomycosis nodosa. The fungal elements are attached to the hair shaft to form nodules along the hair shaft. It predominantly affects scalp hair, although involvement of the beard, mustache, and pubic hairs is also known.
How long does itraconazole last?
Oral terbinafine 250 mg once daily for 6 weeks. Oral itraconazole 100 mg twice-a-day after a meal, with a citrus drink for 1 to 2 weeks. Counseling on the maintenance of good scalp hygiene, avoidance of sharing combs, etc.
What is trichoscopy for hair?
Trichoscopy: Hair examination using tri choscopy may provide useful information for the correct diagnosis by differentiating pseudonits from nits. [9] [10] [11] It shows multiple oval or elongate-shaped brown-black nodules on the hair shaft.
How to get rid of fungal infection?
Shaving the head of all the hair is the best way to get rid of this fungal infection. However, this option may not be acceptable to females for aesthetic reasons.
What is a KOH mount?
Histopathology. In histological sections or 10% potassium hydroxide (KOH) mounts, the nodules are observed to be made up of closely packed brown hyphae held in a mass by a viscous or cement-like substance. At the edges of the nodules, regularly aligned hyphae and arthroconidia, 4 to 8 microns in diameter, can be seen.
How big are hair nodules?
The nodules are usually multiple and vary in size from microscopic to 1 mm or more in diameter. They are oval or elongated in shape with their thickness tapering from one end to the other or from the middle to the edge. They are composed of a compact cellular substance that surrounds the hair shaft.
What is the second type of cortex digestion?
The second type was produced by active boring hyphae , forming channels as they penetrated vertical to the axis of hair.
What is the Evidence?
J Am Acad Dermatol. vol. 55. 2006. pp. 956-61. (A case series of eight children with white piedra in the United States who did not shave their hair, five of whom had clearance with itraconazole 100mg daily and 2% ketoconazole shampoo for one month, and two of whom had clear ance with fluconazole 6mg/kg/day and 2% ketoconazole shampoo for 3 weeks.)
What causes white pidra?
White piedra is caused by fungi of the genus Trichosporon. T inkin and T ovoides are the species most likely to be found on pubic hair and scalp hair, respectively. Patients who have white piedra of the pubic hair are likely to have simultaneous pubic hair infection with coryneform bacteria. This bacterial infection of the pubic hair is a condition known as trichobacteriosis or, confusingly, trichomycosis pubis.
How to treat white pidra of the scalp?
White piedra of the scalp in a patient who does not want to shave and who has not responded to topical agents can be treated with oral itraconazole 100mg daily for 8 weeks. White piedra of the genital area that is recurrent can be treated with a combination of shaving and topical antifungals, and ensuring disinfection of undergarments, bedding, and towels. Spontaneous remission of white piedra of the pubic hair has been reported.
What is the microscope examination of hair shaft disorders?
Microscopic examination of hair shaft disorders such as monilethrix and trichorrhexis nodosum will reveal their characteristic morphology without fungal hyphae. Wood’s light examination of the affected areas will demonstrate fluorescence in the presence of Corynebacterium that cause trichomycosis axillaris and pubis, but the presence of these bacteria do not rule out a concomitant piedra infection.
How long does Black Piedra last?
Black piedra has been reported to respond to oral terbinafine 250mg daily for 6 weeks, as well as to a variety of topical antifungal and keratolytic agents, but shaving the hair remains the best approach.
What is white piedra?
White piedra can occur in patients of any age, and tends to occur in temperate areas of the world. The pubic, axillary, and facial hair are more often affected than scalp hair. Patients have white to light brown soft papules loosely attached at irregular spaces along the hair shaft. They can cause breakage of the hair.
How to tell if a piedra is white or black?
Diagnosis of both types of piedra can be made by microscopic examination of the nodules on the hair shaft. The hair should be plucked and prepared with 10% potassium hydroxide solution and a fungal stain such as chlorazole black. The nodules of black piedra consist of tightly packed hyphae and spores, and are generally circumferential around the hair shaft, as opposed to nits. White piedra nodules are made up of loosely packed hyphae, arthroconidia, and blastoconidia, are also around the hair shaft circumferentially, and often associated with peripheral bacteria.
Why is my piedra white?
The technical cause of white piedra is a fungus of the trichosporon variety. This fungus is found mostly in soil. It is not clear how people get this infection but it may be that people who get white piedra already have the trichosporon fungus on their skin.
What are the complications of white piedra?
The most common complication of white piedra is hair loss and/or brittle hair. People who are immunosuppressed (who have HIV or are undergoing chemotherapy), can have pruritic (characterized by a burning sensation) or necrotic (consisting of dead tissue) nodules or papules. These can cause intense itching and discomfort.
What is the difference between white piedra and tinea versicolor?
Tinea versicolor vs. white piedra. Tinea versicolor is a fungal skin infection caused by yeast. People with this condition can get scaly patches anywhere on their body. These patches can be lighter or darker than your natural skin color. Unlike these skin patches, white piedra appears as nodules around the hair shaft that are a white-to-tan in ...
How to diagnose white piedra?
Doctors diagnose white piedra by examining the hair shaft and the nodules. They may also perform tests on the fungus to help pinpoint their diagnosis.
What causes white pidra?
White piedra is a relatively rare fungal infection of the hair shaft. It is caused by a yeast-like fungus called Trichosporon. The two types of fungus that cause white piedra are T. inkin and T. ovoides. White piedra is generally not contagious.
What is black piedra?
Black piedra is a cousin to white piedra. The nodules that characterize black piedra are hard, black/brown in color, and difficult to remove. Black piedra is more commonly seen in scalp hair and not facial or body hair.
Does white piedra make you itchy?
Unlike lice, white piedra will not produce a severely itchy sensation or make you feel like something is crawling along your head. White piedra nodules are easy to remove while lice nits are not.
How do dermatophytes differ from other dermatophytes?
Dermatophytes differ in their host interactions. 1 Anthropophilic dermatophytes, specific to human disease, are distinguished from zoophilic dermatophytes, which have specific animal associations but may be transmitted to humans, and from geophilic dermatophytes, which are occasionally pathogenic to humans or animals but primarily grow on decaying keratinous material. Infection of humans by zoophilic dermatophytes usually elicits a pronounced inflammatory response. Such inflamed lesions may resolve spontaneously, unlike the often chronic lesions of anthropophilic dermatophytoses.
How to distinguish black piedra from white piedra?
Black piedra can be distinguished from pediculosis, white piedra (caused by Trichosporon species), tinea capitis and other similar conditions by examining individual hairs in a KOH preparation using light microscopy. The black piedra nodules are composed of aligned, dichotomously branching hyphae surrounding a cement-filled stroma with areas containing asci, each of which holds eight fusiform, curved ascoconidia. Piedraia hortae grows on routine mycologic culture media.
What are superficial mycoses?
The superficial mycoses include those that superficially infect skin or hair ( Fig. 15-4 ). Malassezia furfur (tinea versicolor, pityriasis versicolor) infection of the skin causes hypopigmented or hyperpigmented macular lesions along the trunk of the body. Exophiala werneckii (tinea nigra) infection is usually asymptomatic and superficial, with hypopigmented areas appearing on the palms or on tanned skin. Associated lesions are usually flat and dark as a result of infection of stratum corneum layers of the epidermis. Piedra is a general term for fungal infection of hair shafts. Piedraia hortae (black piedra) infection results in hard black deposits along the hair shafts, while Trichosporon beigelii (white piedra) forms white deposits similar to a collar-like sleeve around hair follicles.
What is black piedra?
Black piedra. Black piedra is a fungal infection of the hair shafts of humans and animals caused by Piedraia hortae. The source of the organism appears to be the soil; in some cases, exposure results from use of plant oil in hair. 142 Infection occurs predominantly in the tropical climates of Central and South America, southeast Asia, ...
How are C. albicans acquired?
C. albicans is often acquired in the birth canal or in infancy from caregivers. 1 Generally, an individual harbors only one or two strains. Cutaneous candidosis is predisposed to by warm, moist conditions with abrasion, especially in the diaper rash of infancy but also in adult occupations that involve wet hands. In the latter cases, paronychia or interdigital erosion frequently results. Intertriginous candidosis occurs in moist body folds and is exacerbated by diabetes mellitus or obesity. Chronic mucocutaneous candidosis (CMC), in which skin and mucosa are extensively colonized by C. albicans, results from inherited defects in cellular immunity 1 (see also Chapter 78 ).
Where does candidosis come from?
Superficial candidosis is in the majority of cases derived from the individual's own endogenous reservoir in the mouth, gastrointestinal tract, lower genital tract, or skin. Cutaneous candidosis is particularly common in infants, at least 10% of whom have candidal skin colonizations.
What is a phaeohyphomycosis?
Phaeohyphomycosis (chronic, subcutaneous fungal infection caused by pigmented opportunistic fungi) Hormodendrum, Drechslera, Phialophora, Curvularia, Cladosporium. Single or multiple nodules; lesions may be grossly or microscopically pigmented, nonpruritic, nonpainful, and cool to the touch.
What causes tinea capitis?
Other fungi that may cause tinea capitis include Trichophyton schoenleinii and Trichophyton megninii in Southern Europe and Africa, and Trichophyton violaceum in the Middle East. The fungus Microsporum gypseum can also sometimes cause tinea capitis.
How to treat seborrheic dermatitis?
There are several treatments for seborrheic dermatitis. The simplest involves medicated anti- dandruff type shampoos to control the skin proliferation and scaling. Several shampoos might be recommended for alternating use on different days and each with its own particular activity.
How can ringworm be passed from one person to another?
Ringworm is contagious. It can be passed from one person to the next by direct skin-to-skin contact. You can also catch ringworm through contact with contaminated items such as combs, unwashed clothing, and shower or pool surfaces. Treatment for ringworm varies depending on the particular fungus involved.
What is ringworm on the scalp?
Ringworm is the same thing as athlete's foot, and the same kind of fungal infection that can affect the nails too. On the scalp, ringworm usually begins as a small pimple that progressively expands in size, ...
What is the best treatment for fungus in hair?
As an alternative to griseofulvin, newer anti-fungal drugs like terbinafine, itraconazole, and fluconazole can be prescribed. Folliculitis. Folliculitis is a term for inflammation of hair follicles. It looks like acne with little rings of inflammation surrounding the opening of a hair follicle.
What does it mean when your ringworm is red?
Affected areas are often itchy, red, and inflamed, with scaly patches that may blister and ooze. The patches are usually redder around the outside with a more normal skin tone in the center. This may create the appearance of a ring -- hence the name, ringworm.
What causes a scaly patch on the scalp?
On the scalp, ringworm usually begins as a small pimple that progressively expands in size, leaving scaly patches of temporary baldness . The fungus gets into the hair fibers in the affected area and these hairs become brittle and break off easily, leaving a bald patch of skin. Affected areas are often itchy, red, and inflamed, with scaly patches that may blister and ooze. The patches are usually redder around the outside with a more normal skin tone in the center. This may create the appearance of a ring -- hence the name, ringworm.
What is white piedra?
White Piedra is an unusual asymptomatic superficial fungal infection of the hair, characterized by the presence of numerous, discrete, soft, asymptomatic nodules loosely attached to the infected hair shafts. It may occur on the scalp, eyebrows, eyelashes, beard, axilla or in the groin. Compared with Black Piedra, which almost always ...
How to treat a wet hair disorder?
The disorder can be controlled by shaving and by local application of 5% ammoniated mercury ointment, topical 2% miconazole, 2% ketoconazole or 1% terbinafine four times a day for a period of 2 weeks or till remissions occur.[1] Oral itraconazole therapy has also been suggested.[6] Although it relapses frequently, removal of the affected hair is usually curative, with few recurrences.
What is the size of a cream-colored nodule?
Whitish to cream-colored easily detachable nodules of size 1-1.5 mm present over the shaft of almost all the scalp hair
Where does white piedra occur?
It may occur on the scalp, eyebrows, eyelashes, beard, axilla or in the groin. Compared with Black Piedra, which almost always occurs on the scalp hair, White Piedra less commonly affects the scalp hair and is more common on other hairy sites of the body.
How long does it take for yeast to grow in agar?
Culture (in agar without cycloheximide) grew yeast-like creamy white colonies after 48 h of incubation
Does white piedra affect hair?
DISCUSSION. Human White Piedra may affect hairs of the scalp, axilla or crural areas. White Piedra of the scalp occurs with a low incidence in tropical and subtropical countries.[2,3] People of all age groups are affected, with a higher incidence in young women.
Can Trichosporon spp. be speciated?
Thus, the cultural characteristics confirmed Trichosporon spp. although speciation was not possible. Both the patients were advised to keep the hair dry and were treated with topical application of 1 in 2,000 mercuric perchloride for 3 months along with trimming of the hair regularly.
How to distinguish black piedra from white piedra?
Black piedra can be distinguished from pediculosis, white piedra (caused by Trichosporon species), tinea capitis and other similar conditions by examining individual hairs in a KOH preparation using light microscopy. The black piedra nodules are composed of aligned, dichotomously branching hyphae surrounding a cement-filled stroma with areas containing asci, each of which holds eight fusiform, curved ascoconidia. Piedraia hortae grows on routine mycologic culture media.
What causes black pidra on scalp?
Black piedra is another infection of the hair shafts that is caused by a black yeast, Piedraia hortae. The disease is rare and confined mainly to parts of the humid tropics. The infection manifests as small black nodules on the hairs of the scalp and less commonly elsewhere. These have to be distinguished from pediculosis, but itching is usually absent in black piedra. With direct microscopy, these nodules can be shown to be composed of hyphal elements and small ascospores of the causative agent within a dark cement-containing stroma. Treating hairs with a topical salicylic acid or an azole cream is usually sufficient, although relapse is common.
What is a piedra?
Piedra. Piedra is a superficial fungal infection of the hair shaft seen most commonly in tropical climates. It presents in two distinct clinical varieties, black piedra and white piedra, caused by Piedraia hortae and Trichosporon species, respectively.
What is the name of the infection that affects both sexes and all ages?
Piedra. Piedra is an asymptomatic infection of the hair shaft 92 also known as trichomycosis nodularis. It affects both sexes and all ages. White piedra is more common in temperate and semi-tropical climates (South America, India, Africa, Japan, Middle East and southern USA).
What is a differential diagnosis of lice?
Differential diagnosis includes lice (see Chapter 37 ), seborrheic dermatitis, trichomycosis axillaris, and inverse psoriasis. In trichomycosis axillaris , a benign infection of axillary or pubic hair by Corynebacterium species, yellow-tan deposits form on hair shafts. This disorder may be difficult to distinguish visually from white piedra, but KOH examination of the hair deposits will demonstrate the hyphae of Trichosporon in white piedra.
What does white piedra do to hair?
The nodules are hard and firmly attached to the scalp hair, especially the frontal area.72 White piedra affects the pubic and axillary hair , moustaches, eyebrows and eyelashes.
What is a clinical presentation of a hair shaft infection?
The clinical presentation is the finding of multiple 1–2 mm hard, darkly pigmented oval nodules adherent to hair shafts. Infection is normally restricted to scalp hair but may involve hair at any site. Multiple nodules may be present on a single hair, weakening the hair shaft and possibly resulting in breakage. Patients do not experience pruritus and they are otherwise asymptomatic apart from the cosmetic effects of the nodules; in fact, some cultural groups in endemic areas consider this infection to be cosmetically appealing and encourage practices that result in its development. 144
Are You Confident of The Diagnosis?
Treatment Options
- Both black and white piedra can be treated by shaving the hair. White piedra can also be treated with a variety of topical antifungal agents, including topical imidazoles, ciclopirox, 2% selenium sulfide lotion, Castellani’s paint, pyrithione zinc, chlorhexidine solution, ketoconazole shampoo, econazole or miconazole cream, and topical amphotericin B. Topical keratolytics such as 30% s…
Optimal Therapeutic Approach For This Disease
- When it is possible to shave the affected area, this is the preferred treatment for both white and black piedra. Genital infections with white piedra often recur, so combining shaving with a short course (1-2 weeks) of a topical antifungal may be warranted for initial treatment. Ensuring that all clothing, bedding, and towels that come in contact with the areas have been washed will help to …
Patient Management
- Patients suspected of having white piedra should be counseled to shave the affected areas, and to apply topical antifungal and antibacterial agents to treat a coinfection with Corynebacterium species. White piedra of the pubic hair can frequently recur, and measures such as disinfecting all garments, bedding, and towels may help to prevent recurrence. Close contacts are not always in…
What Is The Evidence?
- Kiken, DA, Sekaran, A, Antaya, RJ. “White piedra in children”. J Am Acad Dermatol. vol. 55. 2006. pp. 956-61. (A case series of eight children with white piedra in the United States who did not shave their hair, five of whom had clearance with itraconazole 100mg daily and 2% ketoconazole shampoo for one month, and two of whom had clearance with fluconazole 6mg/kg/day and 2% k…