PIEDRA

trichomycosis nodularis/ trichomycosis nodosa

An asymptomatic superficial fungal

infection of the hair shaft

Consists of white and black forms


ETIOLOGY
Caused by a yeast-like fungus
pathogenic species of the
Trichosporon genus
• Trichosporon asahii
• Trichosporon ovoides
• Trichosporon inkin
• Trichosporon mucoides
• Trichosporon asteroids
• Trichosporon cutaneum
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PIEDRA
EPIDEMIOLOGY
Most common in temperate and semitropical climates of
South America and Asia, the Middle East, India, Africa, and
Japan
Affects facial, axillary, and genital hair more commonly than
scalp hair.
T. ovoides is found more commonly on scalp hair, T. inkin on
pubic hair, and T. asahii on other body surfaces.
Person-to-person transmission is rare, and infection is not
associated with travel to endemic area.
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Clinical Findings
Softer and less-adherent whitish to beige–colored concretions
that are discrete or may coalesce into sleeve-like structures
along the hair shaft, easily detached.
Black Piedra: almost always occurs on the scalp hair
White Piedra: less commonly affects the scalp hair, more
common on other hairy sites of the body

Broken hairs, although sometimes present, are less common

than in black piedra.
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WHITE DIAGNOSIS
PIEDRA

KOH PREPARATION (KOH 10% wet mount)

The nodules are less organized and more intrapilar appearance than do nodules of black piedra.

Hyphae are arranged perpendicularly to the hair shaft.

T. asahii thrives on SDA and it is inhibited by cycloheximide.

Microscopy readily differentiates piedra from nits, hair casts, developmental hair shaft defects, and
trichomycosis axillaris. In addition, the nodules of trichomycosis axillaris are usually smaller and may
fluoresce under a Wood lamp.
WHITE Pediculosis capitis /Head Lice
• School children ages 3 to 11, especially girls with long hair and a propensity to
PIEDRA •
share hair care tools and accessories, are at greatest risk.
It is light tan to medium brown and is about the size of a sesame seed.
• Transmission is via direct contact or by fomites such as combs, brushes, hats,
helmets, headphones.
• The occipital scalp, posterior ears, and neck are the most common sites involved
with head lice.
• Nits may be seen on examination of proximal hair shafts or on clothing seams in
cases of body lice

Differential
Tinea Capitis
Diagnosis • Tinea is an infection of keratinaized cutaneous structures by a unique group of fungi
called dermatophytes; arthrospores of these species can survive in skin scales for
up to 12 months.
• Transmission is most often person to person, then from animals, and least
commonly, from soil.
• Tinea capitis is dermatophytic infection of the scalp and hair that occurs primarily in
children
• May present as noninflammatory scaling patches, scaling, and broken-off hairs, or
severe, painful inflammation with painful, boggy nodules that drain pus (kerion) and
result in scarring alopecia, especially if there is secondary infection
• Noninflammatory scaling a ppears as diffuse or circumscribed alopecia.
• “Gray patch” appears as partial alopecia.
• “Black dot” lesions are broken-off hairs near the scalp that give appearance of
“dots” (swollen hair shafts) in dark-haired patients
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Management
Topical agent
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
Shaving
Shaving the infected hair is
curative and represents the
best treatment
Systemic antifungal agent
Such as itraconazole.
It’s being advocated due to high relapse
rates, as well as evidence for intrafollicular
organisms in white piedra