Black piedra

Last Updated: 2019-08-26

Author(s): Anzengruber F., Navarini A.

ICD11: -

Piedra nigra, trichomycosis nodosa nigra.

Special form of the white Piedra.

Especially the tropics, South America, the Far East.

  • Pathogen: Piedraia hortae.
  • P. hortae lives on human hair, but also on plants.

Macroscopically visible, coarse palpable, blackish nodi in the area of the hair shaft.

  • Medical history
  • Clinic 
  • Mycological Diagnostics

  • Cutting off the hair.
  • Laundry should be washed at least 60°C.


System therapy 

  • Terbinafin (Lamisil® Tablet) p.o. 250 mg 1x per day for 6 weeks.

  • For disseminated infestation:
  • Amphotericin B intravenously, initial: 0.1 mg/kg bw/day, if necessary increase of dose up to 1 mg/kg bw/day.

  • Alternatively: Flucytosine intravensously 40-50 mg/kg bw/d 4x per day for 4 weeks.

  1. Gip, L., Black piedra: the first case treated with terbinafine (Lamisil). Br J Dermatol, 1994. 130 Suppl 43: p. 26-8.
  2. Bonifaz, A., et al., Tinea versicolor, tinea nigra, white piedra, and black piedra. Clin Dermatol, 2010. 28(2): p. 140-5.
  3. Kanitakis, J., et al., Black piedra: report of a French case associated with Trichosporon asahii. Int J Dermatol, 2006. 45(10): p. 1258-60.
  4. Gip, L., Terbinafine for black piedra. Lancet, 1993. 341(8853): p. 1164.