Black piedra

Piedra nigra, trichomycosis nodosa nigra.

Special form of the white piedra.

Mainly tropics, South America, Far East.

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

Macroscopically visible, dermally palpable, blackish nodules in the area of the hair shaft.

• Anamnesis
• Clinical
• Mycological diagnosis

• Cut the hair
• Washing should be done at a minimum of 60°C

System therapy

• Terbinafine p.o. 250 mg 1x daily for 6 weeks
• In disseminated infestation:
  • Amphotericin B i.v., initial: 0.1 mg/kg bw/d., if necessary increase the dose up to 1 mg/kg bw/d
  • Alternatively: flucytosine i.v. 40-50 mg/kg bw/d 4x daily 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.