What are the other Names for this Condition? (Also known as/Synonyms)

• Tinea Blanca
• Trichomycosis Nodularis
• Trichosporonosis Nodosa

What is White Piedra (Definition/Background Information)

• White Piedra is a fungal infection caused by several different fungal Trichosporon species. It most commonly affects the hair but can also rarely infect the nails and skin. Involvement of the scalp is usual, with body hair less frequently being involved
• The condition is more common in tropical and subtropical regions and affects people of all ages. It is often seen in those with hair that is frequently wet, such as swimmers, people living in humid climates, and people who frequently wash their hair. The fungus is usually contracted by direct contact with contaminated soil or water
• The fungus forms small soft concretions cylindrically arrayed along the hair shafts. These fungal colonies can vary in size and color. The fungus uses the hair shaft as its nutritional source, causing itching, breakage, and discoloration of the hair. In severe cases, it can cause hair loss
• White Piedra is usually diagnosed based on the characteristic appearance of the hair shaft. Still, a fungal culture or a skin scraping for a microscopic exam may be taken to confirm the diagnosis
• The treatment of White Piedra includes antifungal shampoos, with ketoconazole as the active ingredient. Clipping or shaving of the involved hair is a helpful first measure.  Oral antifungal medications, particularly terbinafine, may be prescribed
• To prevent White Piedra, practice good hygiene, such as washing hair and scalp regularly, especially after contact with soil. Avoiding sharing personal grooming items and drying hair thoroughly after washing are prudent measures to be considered
• With proper treatment, most people recover from White Piedra without complications. The hair will typically grow back, but the areas with prior involvement may be discolored or have a rough texture

Who gets White Piedra? (Age and Sex Distribution)

• White Piedra is more common in people living in tropical and subtropical regions
• It can affect people of all ages, genders, and ethnicities

What are the Risk Factors for White Piedra? (Predisposing Factors)

Factors that increase the risk of contracting White Piedra include:

• Living in tropical and subtropical regions (humid climates)
• Having hair that is frequently wet
• People who work in agriculture or otherwise have contact with soil and still water.
• Frequent and extensive contact with the soil
• Possibly, sharing personal grooming items with an infected person

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of White Piedra? (Etiology)

White Piedra is caused by a fungus called Trichospon species, which can survive in the hair, nails, and skin. 

• The fungus is usually contracted by direct contact with contaminated soil
• Trichosporon ovioides most often infects scalp hairs, Trichosporon inkin infects pubic hair, Trichosporon cutaneum and T. loubieri infect the skin

What are the Signs and Symptoms of White Piedra?

• White Piedra forms soft concentric nodules with cylindrically arranged shafts that vary in size and color along the hair. White is the most common color, but green, red, or light brown are also seen
• The fungal colonies can cause itching, breakage, and hair discoloration
• In severe cases, it can cause hair loss

How is White Piedra Diagnosed?

• White Piedra is usually diagnosed based on the characteristic nodules on the hair shafts
• But a fungal culture or a skin scraping for microscopic examination may be taken to confirm the diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of White Piedra?

• In most cases, White Piedra is asymptomatic. However, it can cause hair loss and discoloration
• It can also lead to itching, pain, hair loss, and scarring in severe cases
• Immunocompromised hosts can develop disseminated fungal disease
• The otherwise superficial fungus can spread through the bloodstream to infect the lungs and cause lesions deep in the skin, which can even be fatal

How is White Piedra Treated?

• White Piedra can be treated with antifungal shampoos containing ketoconazole
• Clipping off the hair is a helpful first measure, where cosmetically acceptable
• Oral antifungal antibiotics, such as terbinafine, are sometimes prescribed
• In cases where hair is severely matted or infected, it may need to be shaved or cut off

How can White Piedra be Prevented?

To prevent White Piedra, it is essential to consider the following steps:

• Practice good hygiene, such as washing hair and scalp regularly
• Avoid extensive contact with soil or contaminated water. If exposed, prompt hygiene measures are necessary
• Dry hair thoroughly after washing

What is the Prognosis of White Piedra? (Outcomes/Resolutions)

• With proper treatment, most individuals recover from White Piedra without complications.
• The hair will typically grow back, but it may be discolored or have a rough texture

Immunocompromised patients with disseminated fungal disease will need aggressive systemic treatment. The prognosis may be guarded depending on the state of the patient’s overall health and the response to treatment.

Additional and Relevant Useful Information for White Piedra?

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/health-topics/focused-health-topics/black-piedra-causes-symptoms-diagnosis-and-treatment