By Gary M. White, MD
In black piedra (Piedrai hortai) small black attachments are seen on the hair. In white piedra (Trichosporon beigeli), white attachments are seen. In Spanish, piedra means stone. T beigelii is primarily a soil inhabitant. The disease is seen primarily in the semitropical and temperate climates of South America, Asia and Europe. It may affect the pubic hair, beard and less commonly the scalp, eyelashes and eyebrows. It is thought patients acquire the disease from either bathing in stagnant water or poor hygiene. Coryneformbacteria are often cultured along with T. beigelii and a synergistic infection by both has been proposed.
Usually the hair is cut and either oral or topical antifungal agents are prescribed. Oral terbinafine 250 mg/d for 6 weeks was effective. Other treatments include oral itraconazole, topical imidazoles, ciclopirox olamine, selenium sulfide, zinc pyrithione and Castellani paint.
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