Piedra

No Results

No Results

processing….

Piedra, which means “stone” in Spanish, is an asymptomatic superficial fungal infection of the hair shaft. In 1865, Beigel ^[1] first described piedra in The Human Hair: Its Structure, Growth, Diseases, and Their Treatment; although, he may have been describing Aspergillus infection.

In 1911, Horta classified piedra into two types. The first is black piedra, which is caused by Piedraia hortae. The second is white piedra. The etiological agents of white piedra, originally named Pleurococcus beigelii and later Trichosporon beigelii, are now called Trichosporon asahii and 5 other species: Trichosporon ovoides, Trichosporon inkin, Trichosporon mucoides, Trichosporon asteroides, and Trichosporon cutaneum. These 6 organisms are all causative agents of white piedra. T asahii is considered most closely linked to white piedra, although some authorities believe T ovoides is the main agent of white piedra of the scalp. Use of the term T beigelli should be avoided. ^[2]

The two types of piedra occur in different climatic conditions. Black piedra is most common in the tropical regions of the world that have high temperatures and humidity. For example, black piedra may occur in many central South American countries, including Brazil, as well as in Southeast Asia. Black piedra is rare in the United States. White piedra is more common in temperate and semitropical climates, such as those in South America, Asia, Europe, Japan, and parts of the southern United States.

In addition, the black piedra and white piedra affect the hair in different body locations. Black piedra usually affects scalp hair, whereas white piedra more commonly affects pubic hair, axillary hair, beards, mustaches, and eyebrows and/or eyelashes. However, in Brazil, white piedra is reported to affect scalp hair most commonly. ^[3] White piedra affects horses and monkeys, in addition to humans. Black piedra occurs in monkeys and humans.

Both types of piedra ultimately may lead to hair breaking because the shaft is weakened by cuticular penetration. In patients who are immunocompromised, dissemination of T asahii can occur, causing purpuric or necrotic cutaneous papules and nodules. Culture or biopsy samples from skin lesions may reveal the causative organism. Related organisms may be found on animal hair, in soil, or in stagnant water. ^[4] Gonzalez et al documented outbreaks of clinical mastitis caused by T asahii in dairy herds. This intramammary infection of affected cows causes hyperthermia, swelling of the udder, and decreased milk production or agalactia; this infection can be fatal in cows. ^[5]

The environment and typical skin flora are the 2 main sources of infectious agents that cause piedra. The source of infection in black piedra, P hortae, appears to be in the soil; however, infection also has been traced to organisms in stagnant water and crops. ^{[6, 7]} The source of infection for white piedra, typically T asahii, can be present in the soil, air, water, vegetable matter, or sputum or on body surfaces. ^[4] However, the mode of infection in humans is not clear. Trichosporon inkin and Trichosporon mucoides have also been documented as unusual causes of scalp hair white piedra. ^{[8, 9]} White piedra has been described in horses, monkeys, and dogs. ^[10]

Trichosporon species may also be causative agents of onychomycosis. A German study showed that among yeasts, they represented 10% of such infections. ^[11] T inkin and T ovoides may be human nail disease pathogens in Brazil. ^{[12, 13]} In addition, T asahii fungemia may develop in clinically deteriorated patients with or without an underlying hematological malignancy, ^[14] as in a neutropenic patient with acute leukemia. ^[15]

T asahii can cause white piedra and occasionally an onychomycosis. ^{[16, 17]} The genus Trichosporon Behrend consists of 6 human pathogenic species: T asahii, T mucoides, T ovoides, T asteroides, T cutaneum, and T inkin and all of which belong to the class Basidiomycetes. ^{[10, 18]} These species are the causative agents of piedra and other superficial infections as well as mucosa-associated systemic mycosis. ^[18] Cladosporium cladosporioides may also cause white piedra. ^[19]

In Brazil Trichosporon ovoides and Trichosporon inkin are common causative agents of white piedra, producing nodules in genital hair or on the scalp. ^[20] Of Trichosporon species isolated from 10 clinical samples in a 2008 study, T ovoides was predominant, being found in 7 samples, while T inkin was identified just in two of them.

United States

White piedra is quite common in parts of the southern United States and less so elsewhere in America. However, white piedra may be emerging as a commonly seen hair and scalp infection in the northeastern United States. ^{[21, 22]}

International

Black piedra is most common in tropical regions such as South America, Far East, and the Pacific Islands. At one time, black piedra reportedly was endemic in Brazilian Indians living in the northern area of midwestern Brazil. ^[23] This trend may have been linked to the Brazilian Indians’ cultural use of plant oils in their hair.

White piedra is more common in temperate and semitropical climates, such as those in Asia, Europe, Japan, and parts of the southern United States. ^{[24, 25]} White piedra caused by T cutaneum was identified in 5.8% of the children frequenting a day care in northeastern São Paulo State, Brazil. ^[26]

A combination of black and white (mixed) piedra has been speculated to represent a unique and probably underreported variety mainly restricted to scalp hair in young Muslim women who wear a scarf (hijab). ^[27]

In the United States, the occurrence of piedra may be higher in blacks than in whites; however, many cases may be underreported because nodules of piedra may be inconspicuous. ^[28]

Both sexes are affected equally. Black piedra initially was believed to be more common in men than in women; however, a study among the Zoro Indians of Brazil revealed no significant differences between the sexes. ^[6] In another study among Brazilian Indians, black piedra affected both sexes equally. ^[23]

Twenty-three cases of scalp white piedra were described in Brazil, with a high incidence in women (87%) and preschool children aged 2-6 years (74%). ^[10]

Individuals of all ages are affected. In a study of Brazilian Indians, persons of all ages were affected, from young children to adults older than 70 years, although black piedra infected young adults most frequently. ^[23] In one series of 23 Brazilian patients with scalp white piedra, a high incidence was found in preschool children aged 2-6 years (74%). ^[10]

The prognosis after treatment is good. Removal of the affected hair is usually curative, with few recurrences. Even without treatment, spontaneous remissions can occur.

Cosmetic morbidity occurs because piedra may affect the patient’s body image; the hair shaft may break and/or the patient may need to shave the affected hair.

Trichosporon, a causative pathogen of white piedra and summer-type hypersensitivity pneumonitis, can rarely produce a fatal disseminated trichosporonosis, a concern in immunocompromised persons. ^[29]

Beigel H. The Human Hair. Its Structure, Growth, Diseases, and Their Treatment. London, England: Renshaw; 1869.

Schwartz RA. Superficial fungal infections. Lancet. 2004 Sep 25-Oct 1. 364(9440):1173-82. [Medline].

Londero AT, Ramos CD, Fischman O. White piedra of unusual localization. Sabouraudia. 1966 Oct. 5(2):132-3. [Medline].

Rippon JW. Medical Mycology. The Pathogenic Fungi and the Pathogenic Actinomycetes. 3rd ed. Philadelphia, Pa: WB Saunders; 1988. 142: 163-8.

González RN, Wilson DJ, Sickles SA, Zurakowski MJ, Weybrecht PM, Walsh AK. Outbreaks of clinical mastitis caused by Trichosporon beigelii in dairy herds. J Am Vet Med Assoc. 2001 Jan 15. 218(2):238-42. [Medline].

Coimbra Junior CE, Santos RV. Black piedra among the Zoró Indians from Amazônia (Brazil). Mycopathologia. 1989 Jul. 107(1):57-60. [Medline].

Kwon-Chung KJ, Bennett JE. Piedra (tinea nodosa trichomycosis nodularis, trichomycosis nodosa, Beigel’s disease, Chignon disease). Medical Mycology. Philadelphia, Pa: Lea & Febiger; 1992. 183-90.

Tendolkar U, Shinde A, Baveja S, Dhurat R, Phiske M. Trichosporon inkin and Trichosporon mucoides as unusual causes of white piedra of scalp hair. Indian J Dermatol Venereol Leprol. 2014 Jul-Aug. 80(4):324-7. [Medline].

Fischman O, Bezerra FC, Francisco EC, da Silva FC, Nishikaku AS, Cavalcanti SD, et al. Trichosporon inkin: an uncommon agent of scalp white piedra. Report of four cases in Brazilian children. Mycopathologia. 2014 Aug. 178(1-2):85-9. [Medline].

Pontes ZB, Ramos AL, Lima Ede O, Guerra Mde F, Oliveira NM, Santos JP. Clinical and mycological study of scalp white piedra in the State of Paraíba, Brazil. Mem Inst Oswaldo Cruz. 2002 Jul. 97(5):747-50. [Medline].

Mugge C, Haustein UF, Nenoff P. [Causative agents of onychomycosis–a retrospective study]. J Dtsch Dermatol Ges. 2006 Mar. 4(3):218-28. [Medline].

Ortega-Springall MF, Arroyo-Escalante S, Arenas R. Onycholysis and Chromonychia: A Case Caused by Trichosporon inkin. Skin Appendage Disord. 2016 Feb. 1 (3):144-6. [Medline].

Magalhães AR, Nishikawa MM, Mondino SS, Macedo HW, Rocha EM, Baptista AR. Trichosporon isolation from human ungueal infections: is there a pathogenic role?. An Bras Dermatol. 2016 Apr. 91 (2):173-9. [Medline].

Karabay O, Madariaga MG, Kocoglu E, Ince N, Kandirali E. Trichosporon asahii fungemia in a patient with non-hematological malignancy. Jpn J Infect Dis. 2006 Apr. 59(2):129-31. [Medline].

Bayramoglu G, Sonmez M, Tosun I, Aydin K, Aydin F. Breakthrough Trichosporon asahii fungemia in neutropenic patient with acute leukemia while receiving caspofungin. Infection. 2008 Feb. 36(1):68-70. [Medline].

Elmer KB, Elston DM, Libow LF. Trichosporon beigelii infection presenting as white piedra and onychomycosis in the same patient. Cutis. 2002 Oct. 70(4):209-11. [Medline].

Manzano-Gayosso P, Hernandez-Hernandez F, Mendez-Tovar LJ, et al. Onychomycosis incidence in type 2 diabetes mellitus patients. Mycopathologia. 2008 Jul. 166(1):41-5. [Medline].

Gueho E, Improvisi L, de Hoog GS, Dupont B. Trichosporon on humans: a practical account. Mycoses. 1994 Jan-Feb. 37(1-2):3-10. [Medline].

Zeller S, Lempert S, Goebeler M, Hamm H, Kolb-Mäurer A. Cladosporium cladosporioides: a so far unidentified cause of white piedra. Mycoses. 2015 May. 58(5):315-7. [Medline].

Magalhaes AR, Mondino SS, Silva M, Nishikawa MM. Morphological and biochemical characterization of the aetiological agents of white piedra. Mem Inst Oswaldo Cruz. 2008 Dec. 103(8):786-90. [Medline].

Kiken DA, Sekaran A, Antaya RJ, Davis A, Imaeda S, Silverberg NB. White piedra in children. J Am Acad Dermatol. 2006 Dec. 55(6):956-61. [Medline].

Goldberg LJ, Wise E, Miller NS. White piedra in a northern climate caused by Trichosporon inkin: A report of two cases. Br J Dermatol. 2015 Apr 2. [Medline].

Fischman O. Black piedra among Brazilian Indians. Rev Inst Med Trop Sao Paulo. 1973 Mar-Apr. 15(2):103-6. [Medline].

Kubec K, Dvorak R, Alsaleh QA. Trichosporosis (white piedra) in Kuwait. Int J Dermatol. 1998 Mar. 37(3):186-7. [Medline].

Therizol-Ferly M, Kombila M, Gomez de Diaz M, Duong TH, Richard-Lenoble D. White piedra and Trichosporon species in equatorial Africa. I. History and clinical aspects: an analysis of 449 superficial inguinal specimens. Mycoses. 1994 Jul-Aug. 37(7-8):249-53. [Medline].

Roselino AM, Seixas AB, Thomazini JA, Maffei CM. An outbreak of scalp white piedra in a Brazilian children day care. Rev Inst Med Trop Sao Paulo. 2008 Sep-Oct. 50(5):307-9. [Medline].

Desai DH, Nadkarni NJ. Piedra: an ethnicity-related trichosis?. Int J Dermatol. 2013 Jun 20. [Medline].

Kalter DC, Tschen JA, Cernoch PL, et al. Genital white piedra: epidemiology, microbiology, and therapy. J Am Acad Dermatol. 1986 Jun. 14(6):982-93. [Medline].

Obana Y, Sano M, Jike T, Homma T, Nemoto N. Differential diagnosis of trichosporonosis using conventional histopathological stains and electron microscopy. Histopathology. 2010 Feb. 56(3):372-83. [Medline].

Elgart ML. Unusual subcutaneous infections. Dermatol Clin. 1996 Jan. 14(1):105-11. [Medline].

Lascaux AS, Bouscarat F, Descamps V, et al. [Cutaneous manifestations during disseminated trichosporonosis in an AIDS patient]. Ann Dermatol Venereol. 1998 Feb. 125(2):111-3. [Medline].

Moyer DG, Keeler C. Nnote on culture of black peidra for cosmetic reasons. Arch Dermatol. 1964 Mar. 89:436. [Medline].

Youker SR, Andreozzi RJ, Appelbaum PC, Credito K, Miller JJ. White piedra: further evidence of a synergistic infection. J Am Acad Dermatol. 2003 Oct. 49(4):746-9. [Medline].

Taj-Aldeen SJ, Al-Ansari HI, Boekhout T, Theelen B. Co-isolation of Trichosporon inkin and Candida parapsilosis from a scalp white piedra case. Med Mycol. 2004 Feb. 42(1):87-92. [Medline].

Ghorpade A. Surrogate nits impregnated with white piedra–a case report. J Eur Acad Dermatol Venereol. 2004 Jul. 18(4):474-6. [Medline].

Viswanath V, Kriplani D, Miskeen AK, Patel B, Torsekar RG. White piedra of scalp hair by Trichosporon inkin. Indian J Dermatol Venereol Leprol. 2011 Sep-Oct. 77(5):591-3. [Medline].

Shivaprakash MR, Singh G, Gupta P, Dhaliwal M, Kanwar AJ, Chakrabarti A. Extensive white piedra of the scalp caused by Trichosporon inkin: A case report and review of literature. Mycopathologia. 2011 Dec. 172(6):481-6. [Medline].

Child Health Alert. Head lice vs. white piedra: something to consider. Child Health Alert. 2007 Jan. 25:1. [Medline].

Lebwohl M, Clark L, Levitt J. Therapy for head lice based on life cycle, resistance, and safety considerations. Pediatrics. 2007 May. 119(5):965-74. [Medline].

Cervantes J, Johr RJ, Tosti A. Dermoscopy of yellow concretions on axillary hair. Skin Appendage Disord. 2018. 4:86-89.

Nakagawa T, Nakashima K, Takaiwa T, Negayama K. Trichosporon cutaneum (Trichosporon asahii) infection mimicking hand eczema in a patient with leukemia. J Am Acad Dermatol. 2000 May. 42(5 Pt 2):929-31. [Medline].

Zhuang K, Ran X, Dai Y, Tang J, Yang Q, Pradhan S, et al. An Unusual Case of White Piedra Due to Trichosporon inkin Mimicking Trichobacteriosis. Mycopathologia. 2016 Dec. 181 (11-12):909-914. [Medline].

Landero J. Long-term pubic dermatitis diagnosed as white piedra. Cutis. 2017 Dec. 100 (6):448-450. [Medline].

Castro RM, Jaeger RG, Talhari S, de Araujo NS. [Black piedra: the study of its etiological agent using scanning electron microscopy]. Rev Inst Med Trop Sao Paulo. 1987 Jul-Aug. 29(4):251-2. [Medline].

Richini-Pereira VB, Camargo RM, Bagagli E, Marques SA. White piedra: molecular identification of Trichosporon inkin in members of the same family. Rev Soc Bras Med Trop. 2012 Jun. 45(3):402-4. [Medline].

Hay RJ, Moore M. Mycology. Rook/Wilkinson/Ebling Textbook of Dermatology. 6th ed. Oxford, England: Blackwell Science; 1998. 1291-3.

Roberts SOB, Hay RJ, Mackenzie DWR. The superficial mycoses: tropical superficial infections. A Clinician’s Guide to Fungal Disease. New York, NY: Marcel Dekker; 1984. 92-4.

Khandpur S, Reddy BS. Itraconazole therapy for white piedra affecting scalp hair. J Am Acad Dermatol. 2002 Sep. 47(3):415-8. [Medline].

Li H, Qiao J, Wan Z, Zhang J. In Vitro Interaction of Itraconazole with Amphotericin B, Caspofungin, and Terbinafine Against Clinical Isolates of Trichosporon asahii. Mycopathologia. 2011 May. 171(5):345-8. [Medline].

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

Disclosure: Nothing to disclose.

Rachel Altman, MD Staff Physician, Department of Dermatology, UMDNJ-New Jersey Medical School

Rachel Altman, MD is a member of the following medical societies: Alpha Omega Alpha, Sigma Xi

Disclosure: Nothing to disclose.

Michael J Wells, MD, FAAD Dermatologic/Mohs Surgeon, The Surgery Center at Plano Dermatology

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Christen M Mowad, MD Professor, Department of Dermatology, Geisinger Medical Center

Christen M Mowad, MD is a member of the following medical societies: Alpha Omega Alpha, Noah Worcester Dermatological Society, Pennsylvania Academy of Dermatology, American Academy of Dermatology, Phi Beta Kappa

Disclosure: Nothing to disclose.

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Neil Shear, MD Professor and Chief of Dermatology, Professor of Medicine, Pediatrics and Pharmacology, University of Toronto Faculty of Medicine; Head of Dermatology, Sunnybrook Women’s College Health Sciences Center and Women’s College Hospital, Canada

Neil Shear, MD is a member of the following medical societies: Canadian Medical Association, Ontario Medical Association, Royal College of Physicians and Surgeons of Canada, Canadian Dermatology Association, American Academy of Dermatology, American Society for Clinical Pharmacology and Therapeutics

Disclosure: Nothing to disclose.

Piedra

Research & References of Piedra|A&C Accounting And Tax Services
Source

Share on Facebook

Tweet

Follow us