White piedra

Last Updated: 2020-07-21

Author(s): Anzengruber, Navarini

Beigel 1869.

Trichomycosis nodosa, Piedra alba, Trichosporose.

Hair shaft infection by the saprophytic yeast fungus, Trichosporon beigelii.

Especially in the subtropics.

Pathogens:

  • Trichosporon spp. especially T. beigelii
  • Whitish, roughly palpable, pin-sized nodi in the area of the hair shaft
  • The hair often becomes brittle

In the area of the head, beard and armpit hair. Inguinal infestation.

  • Haircut
  • Laundry should be washed at a minimum of 60°C
  • Systemic therapy
    • Terbinafine p.o. 250 mg 1x a day for 6 weeks
    • In case of 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.
      • Alternative: Flucytosin i.v. 40-50 mg/kg bw/d 4x daily for 4 weeks
  1. Patteson, R.G., Trichomycosis Nodosa: A Bacillary Disease of Hair. Br Med J, 1889. 1(1482): p. 1166-9.
  2. Avram, A., et al., [Clinical and mycological study of 11 cases of genitopubic trichosporosis nodosa (white piedra)]. Ann Dermatol Venereol, 1987. 114(6-7): p. 819-27.
  3. Roshan, A.S., C. Janaki, and B. Parveen, White piedra in a mother and daughter. Int J Trichology, 2009. 1(2): p. 140-1.
  4. Bonifaz, A., et al., Tinea versicolor, tinea nigra, white piedra, and black piedra. Clin Dermatol, 2010. 28(2): p. 140-5.