Summary about Disease
White piedra is a superficial fungal infection of the hair shaft caused by various species of the Trichosporon fungus. It results in soft, white to light brown nodules firmly attached to the hair, primarily affecting hairs on the face (beard, mustache), scalp, eyebrows, and eyelashes. Less commonly, it can affect pubic or axillary hair. It is generally considered a cosmetic problem rather than a serious health concern.
Symptoms
Soft, white to light brown nodules firmly attached to the hair shaft.
Nodules are typically 1-2 mm in length.
The hair is not usually damaged or weakened, although in severe cases, it can become brittle.
May cause mild itching or irritation, but often asymptomatic.
Nodules are usually most noticeable near the scalp or skin surface.
Causes
Infection with Trichosporon* species, most commonly *Trichosporon ovoides* and *Trichosporon inkin*.
Poor hygiene.
Humid and warm climates.
Use of contaminated hair products or sharing of personal care items.
Immunocompromised status (rarely).
Medicine Used
Topical antifungal medications: Shampoos or creams containing ketoconazole, selenium sulfide, clotrimazole, miconazole, or ciclopirox olamine.
Oral antifungal medications: In severe or recalcitrant cases, oral antifungals such as itraconazole or fluconazole may be prescribed.
Is Communicable
White piedra is considered mildly communicable through direct contact with infected hair or contaminated objects (e.g., combs, brushes, towels).
Precautions
Maintain good personal hygiene, including regular hair washing.
Avoid sharing combs, brushes, towels, and other personal care items.
Keep hair dry, especially in humid environments.
Promptly treat any suspected fungal infections.
If infected, avoid close physical contact that could spread the fungus.
How long does an outbreak last?
Without treatment, the infection can persist indefinitely. With appropriate treatment (antifungal medications), the infection usually clears within a few weeks to months. Relapse is possible if predisposing factors are not addressed.
How is it diagnosed?
Visual examination: A healthcare provider can often diagnose white piedra by visually inspecting the hair shafts for the characteristic nodules.
Microscopic examination: Microscopic examination of the affected hair shafts confirms the diagnosis by revealing the presence of fungal elements (arthroconidia).
Fungal culture: A fungal culture can be performed to identify the specific Trichosporon species causing the infection, but it is not always necessary for diagnosis.
Timeline of Symptoms
Initial infection: Fungus begins to colonize the hair shaft.
Gradual nodule formation: Small, soft nodules appear along the hair shaft.
Progression: Nodules enlarge and become more noticeable over time.
Chronic infection: Without treatment, the infection persists with continuous or intermittent nodule formation.
Important Considerations
White piedra is primarily a cosmetic concern and rarely causes serious health problems.
Treatment is usually effective with topical or oral antifungal medications.
Maintaining good hygiene and avoiding sharing personal care items can help prevent recurrence.
If the infection is severe or persistent, consult a dermatologist or other healthcare provider.