Piedra, white B36.2

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

Beige's disease; piedra alba; trichomycosis nodosa; Trichosporosis; white piedra

History
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Beige, 1869

Definition
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Mycosis of the hair shaft by trichosporon species with characteristic white nodules. In case of inguinal infestation, the typical nodules are also found on cotton fibres of underwear.

Pathogen
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Trichosporon spp. (saprophytic yeast fungi), in particular Trichosporon mucoides, T.inkin, T.ashaii, T.ovoides.

Occurrence/Epidemiology
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Mainly subtropical, temperate zones. m:w=1:1;

Localization
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Especially hair on the head, beard and armpits.

Clinical features
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Several white nodules on the hair shaft, strung like pearls, rock-hard, a few millimetres in size. The hair becomes brittle in the area of the nodules.

Differential diagnosis
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Hair shaft anomalies, see below. Hair nodules.

External therapy
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Cutting off the affected hair in case of inguinal infestation. If possible, dispose of the underwear, otherwise boil it. Recurrences are frequent, so continued careful hygiene is important.

Internal therapy
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Antimycotic therapy with Terbinafine (e.g. Lamisil Tbl.) 250 mg/day for 6 weeks. In case of systemic infestation treatment with Amphotericin B, initial dose 0.1 mg/kg bw/day i.v., increase up to 1 mg/kg bw/day. Alternatively flucytosine (ancotil): Adults and children 150-200 mg/kg bw/day i.v. as infusion in 4 doses over 3-4 weeks.

Literature
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  1. Almeida HL et al (1990) White piedra: ultrastructure and a new microecological aspect. Mycoses 33: 491-497
  2. Beige H (1869) in: The human hair: its structure, growth and diseases. Henry Renshaw (London), p 120.
  3. Elmer KB et al (2002) Trichosporon beigelii infection presenting as white piedra and onychomycosis in the same patient. Cutis 70: 209-211
  4. Khandpur S, Reddy BS (2002) Itraconazole therapy for white piedra affecting scalp hair. J Am Acad Dermatol 47: 415-418
  5. Nahass GT et al (1993) Disseminated infection with Trichosporon beigelii. Report of a case and review of the cutaneous and histological manifestations. Arch Dermatol 129: 1020-1023
  6. Nakagawa T et al (2000) Trichosporon cutaneum (Trichosporon asahii) infection mimicking hand eczema in a patient with leukemia. J Am Acad Dermatol 42: 929-931

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Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 29.10.2020