Review Article White Piedra: Review of 131 cases.

This study analyzes the clinical characteristics of patients diagnosed with White Piedra through a systematic review of cases in the literature. A sample of 131 subjects was considered, of which 91.6% were female and most were 18 years of age or younger. Most studies were conducted in Brazil, followed by India, and Mexico. The most common etiologic agent found was Trichosporon spp (34.3%). Most affected patients were asymptomatic (94.6%) and predisposing factors included long hair, use of a hair band or hair accessories, and wet hair. The most common clinical feature was the presence of nodules. The evaluation of treatment effectiveness was hindered by the scarcity of follow-up information in the majority of the studies. It is concluded that White Piedra infection is more common in young women and is associated with hair-related factors.

Efficacy of topical vs combined oral and topical antifungals in white piedra of the scalp.

BACKGROUND: Topical antifungals are the most commonly used therapy in white piedra of the scalp. However, persistence and relapse of infection still pose a significant challenge. Systemic antifungals have been recommended to enhance the therapeutic response. AIMS: To compare the efficacy of topical antifungal alone versus combined topical and oral antifungals in the treatment of white piedra of the scalp. METHODS: Sixty patients with white piedra of the scalp were divided into 3 groups, each containing 20 patients. Group A received topical clotrimazole, group B received combined topical clotrimazole and oral itraconazole, and group C received combined topical clotrimazole and oral terbinafine. The treatment was continued until clearance of infection was confirmed by dermoscopic and mycological examination. Positive responders were followed up for 3 months after treatment. RESULTS: All the patients achieved complete clearance of infection. The median treatment time in group B was significantly shorter than group A (P < .001) and group C (P < .001), respectively. In addition, the median treatment time in group C was significantly shorter than group A (P = .002). No recurrence of infection was noted during follow-up period. CONCLUSION: The three modalities were effective in the treatment of white piedra of the scalp. The most rapid response was observed with the combined use of topical and oral azoles.

Long-term pubic dermatitis diagnosed as white piedra.

The case of a 58-year-old man with a pruritic rash involving the pubic area that had been undiagnosed for 30 years is presented. At least 15 different primary care physicians and dermatologists evaluated the patient during this time period. Multiple treatments were unsuccessful and a definitive diagnosis was not rendered. Wood lamp evaluation of the pubic area revealed hair shaft concretions that were confirmed on histologic evaluation to be white piedra (WP). The patient was successfully treated with topical ketoconazole and the eruption completely resolved. Our case raises awareness of the use of Wood lamp and dermoscopy to evaluate for parasitic infections of the pubic hair shafts when nonspecific dermatitis presents in this area.

White piedra of scalp hair by Trichosporon inkin.

White piedra is a rare fungal infection of hair and is reported to be all the more rare on scalp. Trichosporon inkin is usually associated with white piedra of pubic hair. We report a case of white piedra of scalp hair caused by T. inkin. This is the first case reported from India and the fifth case reported worldwide. A 50-year-old Muslim female presented with white knots over scalp hair. Diagnosis of Trichosporon was made by examining KOH mounts of epilated hair and Lactophenol Cotton Blue preparations of the growth in culture. Automated mini-API test (for biochemical profiles) and Electronmicroscopy studies (for cell wall structures) helped in identification of the species. Mini-API test was also positive for Cryptococcus curvatus which could be due to similarity in biochemical and physiological properties of the two species. Absence of C. curvatus on culture further supports this view. Topical antifungal therapy resulted in clinical clearance within 2 months. Higher incidence of scalp white piedra is observed in Muslim females; contributing factor being the custom of using a veil, leading to higher humidity and limited sunlight exposure.

Tinea versicolor, tinea nigra, white piedra, and black piedra.

Superficial mycoses are fungal infections limited to the stratum corneum and its adnexal structures. The most frequent types are dermatophytoses or tineas. Tinea versicolor involves the skin in the form of hypochromic or hyperchromic plaques, and tinea nigra affects the skin of the palms with dark plaques. White piedra and black piedra are parasitic infections of scalp hairs in the form of concretions caused by fungal growth. Diagnosis of these mycoses is made from mycologic studies, direct examination, stains, and isolation, and identification of the fungi. Treatment includes systemic antifungals, topical antifungals, and keratolytics.

Superficial mycoses in immunodepressed patients (AIDS).

HIV infection has the capacity to distort the epidemiology and clinical course of infectious diseases, producing atypical manifestations and changing diagnoses. Superficial fungal infections are frequent in HIV-positive/AIDS patients and are no exception. These infections are frequently different in immunodepressed patients (AIDS), with a modified course or exacerbations. This chapter discusses the diagnosis and treatment of superficial mycoses in HIV patients, including cutaneous alterations caused by Candida, dematiaceous fungi agents of phaeohyphomycosis, Malassezia spp, dermatophyte, and filamentous nondermatophyte fungi.

Two cases of scalp white piedra caused by Trichosporon ovoides.

White piedra is a superficial fungal infection of the hair shaft, caused by Trichosporon beigelii . We report two cases of white piedra presenting as brown palpable nodules along the hair shaft with a fragility of scalp hairs. T. beigelii was demonstrated in hair culture of both the patients and T. ovoides as a species was confirmed on carbohydrate assimilation test. The first patient responded to oral itraconazole and topical ketoconazole, with a decrease in the palpability of nodules and fragility of scalp hairs at the end of two months.

White piedra in children.

BACKGROUND: White piedra is a fungal infection of the hair shaft caused by species of Trichosporon. Rarely has this infection been reported in the United States. Historically, infected individuals required shaving of their hair to achieve clearance of the infection. OBJECTIVE: We sought to describe 8 cases of Trichosporon scalp infections seen in the northeastern United States. METHODS: We conducted chart review and prospective evaluation of 7 girls and 1 boy seen in two dermatology practices in New Haven, Conn, and New York, NY. RESULTS: Seven girls, ages 4 to 16 years old, and one 4-year-old boy were determined to have Trichosporon scalp infection, all through culture. Of the 8 children who were available for follow-up, 7 had clearance of their infection with a combination of oral azole antifungal medication and azole antifungal shampoo, without shaving the scalp hair. LIMITATIONS: This was a sample of patients from a localized region of the United States. CONCLUSIONS: White piedra is emerging as a commonly seen hair and scalp infection in the northeastern United States. Contrary to prior publications, scalp and hair infection may be successfully treated with a combination of oral azole antifungals and shampoos without shaving the scalp.

Superficial fungal infections.

Superficial fungal infections arise from a pathogen that is restricted to the stratum corneum, with little or no tissue reaction. In this Seminar, three types of infection will be covered: tinea versicolor, piedra, and tinea nigra. Tinea versicolor is common worldwide and is caused by Malassezia spp, which are human saprophytes that sometimes switch from yeast to pathogenic mycelial form. Malassezia furfur, Malassezia globosa, and Malassezia sympodialis are most closely linked to tinea versicolor. White and black piedra are both common in tropical regions of the world; white piedra is also endemic in temperate climates. Black piedra is caused by Piedraia hortae; white piedra is due to pathogenic species of the Trichosporon genus. Tinea nigra is also common in tropical areas and has been confused with melanoma.

Tinea corporis, tinea cruris, tinea nigra, and piedra.

Tinea infections are among the most common dermatologic conditions throughout the world. To avoid a misdiagnosis, identification of dermatophyte infections requires both a fungal culture on Sabouraud's agar media, and a light microscopic mycologic examination from skin scrapings. Topical antifungals may be sufficient for treatment of tinea corporis and cruris and tinea nigra, and the shaving of hair infected by piedra may also be beneficial. Systemic therapy, however, may be required when the infected areas are large, macerated with a secondary infection, or in immunocompromised individuals. Preventative measures of tinea infections include practicing good personal hygiene; keeping the skin dry and cool at all times; and avoiding sharing towels, clothing, or hair accessories with infected individuals.

Trichosporon beigelii infection presenting as white piedra and onychomycosis in the same patient.

Trichosporon beigelii is a fungal organism that causes white piedra and has occasionally been implicated as a nail pathogen. We describe a patient with both hair and nail changes associated with T. beigelii.

[White piedra. Report of a case]. / Piedra blanca. Informe de un caso.

The most common superficial mycosis caused by Trichosporon beigelii is white piedra. We report a 18 years old male that had in several hairs of the scalp, white-yellowish nodules of 1 mm diameter, agglutinated or forming chains, even forming threads, with a greasy aspect. Trichosporon beigelii was identified in cultures. Oral and topical antimycotics were prescribed and the patient was lost from follow up.

Piedra blanca: informe de un caso / White piedra: report of 1 case

The most common superficial mycosis caused by trichosporon beigelii is white piedra. We report a 18 years old male that had in several hairs of the scalp, white-yellowish nodules of 1 mm diameter, agglutinated or forming chains, even forming threads, with a greasy aspect. Trichosporon beiglii was identified in cultures. Oral and topical antimycotics were prescribed and the patient was lost from follow up

Black piedra: the first case treated with terbinafine (Lamisil).

A 23-year-old Swedish Caucasian man presented with typical clinical signs of black piedra of his scalp after his return from 4-months' stay in India. There were black nodules around the hair shafts, and the crushed nodules revealed numerous asci and ascospores on microscopy. Piedraia hortae was isolated from the concretions. He was treated with oral terbinafine 250 mg daily for 6 weeks. At the end of treatment no nodules were visible, but 16 days later a few 'new' black concretions appeared. Microscopy of these nodules revealed markedly degenerated fungal elements, and cultures were negative. No further signs of the disease were seen 2 months after cessation of therapy. In vitro susceptibility tests showed that Piedraia hortae was sensitive to terbinafine. This case demonstrates that terbinafine is effective in the treatment of black piedra.

Piedra branca: revisäo de literatura a respeito de três casos / White piedra: review of the literatura report of three cases

Os autores apresentam três casos de piedra branca comprometendo o couro cabeludo de crianças em idade pré-escolar. O Trichosporon beigelii foi caracterizado por exames micológicos. Revisa-se a literatura abordando aspectos clínicos, micológicos e terapêuticos