Black piedra - Clinicals, Diagnosis, and Management

Dermatology

Clinicals - History

Fact Explanation
Nodules in hair sharft Black piedra is a peculiar hair infection caused by the the superficial mycoses called Piedraia hortae.. It is an asymptomatic fungal infection of the hair shaft, resulting in the formation of nodules of different hardness on the infected hair. Usually hosts do not produce any immune-reactive response, so that they are called as superficial mycoses.. It is characterized by the formation of firmly attached, black and hard nodules around the hair shaft.. Nodules in hair sharft
Black piedra is a peculiar hair infection caused by the the superficial mycoses called Piedraia hortae.. It is an asymptomatic fungal infection of the hair shaft, resulting in the formation of nodules of different hardness on the infected hair. Usually hosts do not produce any immune-reactive response, so that they are called as superficial mycoses.. It is characterized by the formation of firmly attached, black and hard nodules around the hair shaft..
Hair brakage Black piedra mostly affects scalp hair. The affected hair breaking in bits at the level of the nodules can be seen.. Hair brakage
Black piedra mostly affects scalp hair. The affected hair breaking in bits at the level of the nodules can be seen..
History of living in a tropical climates Black piedra is normally distributed in tropical climates,although it has occasionally been reported in other parts of the world. It is commonly found in tropical countries such as South America and South East Asia .. History of living in a tropical climates
Black piedra is normally distributed in tropical climates,although it has occasionally been reported in other parts of the world. It is commonly found in tropical countries such as South America and South East Asia ..
History of application of plant oils on wet hair In certain tropical countries application of plant oils on wet hair is implicated as a favorable factor for piedra infection. It is further favored by the high humidity.. History of application of plant oils on wet hair
In certain tropical countries application of plant oils on wet hair is implicated as a favorable factor for piedra infection. It is further favored by the high humidity..
Metallic sound on combing Piedra itself means "stones" in spanish. Black piedra mostly affects scalp hair with darkly pigmented stony hard nodules firmly attached around the hair shaft. This is able to create a metallic sound on combing.. Metallic sound on combing
Piedra itself means "stones" in spanish. Black piedra mostly affects scalp hair with darkly pigmented stony hard nodules firmly attached around the hair shaft. This is able to create a metallic sound on combing..
Difficulty in combing hair Patients are often complained difficulty in combing hair due to the nodules in their hair shaft.. Difficulty in combing hair
Patients are often complained difficulty in combing hair due to the nodules in their hair shaft..
History of poor hygiene and history of sexual activity with a infected person Factors such as poor hygiene, long hair, excessive use of hair oil, may contribute to the infection. Sexual transmission found to be occurred in both black and white piedra.. History of poor hygiene and history of sexual activity with a infected person
Factors such as poor hygiene, long hair, excessive use of hair oil, may contribute to the infection. Sexual transmission found to be occurred in both black and white piedra..
History of long term covering head with veils Cultural practices such as tying of veil, specially when done on wet hair , also found to be a contributory factor for infection.. History of long term covering head with veils
Cultural practices such as tying of veil, specially when done on wet hair , also found to be a contributory factor for infection..

Clinicals - Examination

Fact Explanation
Nodules located to a specific areas Black Piedra is characterized by the presence of firm black, hard, gritty nodules which are actually a mass of fungus cells on the hair shaft. Those nodules are commonly found in scalp, but not limited to that. If may also found in hairs of the beard, moustache and pubic hair with the fungal activity limited to the cuticle.. Nodules located to a specific areas
Black Piedra is characterized by the presence of firm black, hard, gritty nodules which are actually a mass of fungus cells on the hair shaft. Those nodules are commonly found in scalp, but not limited to that. If may also found in hairs of the beard, moustache and pubic hair with the fungal activity limited to the cuticle..

Investigations - Diagnosis

Fact Explanation
Direct microscopic examination Disease is mainly diagnosed by clinical history and examination. Other method is direct microscopy using KOH solution.Wet mount of the nodules in KOH is confirmatory. There we can see organized brown spores in black piedra invading the hair.Matured nodules will show asci that means sexual spores containing eight ascopore. Each one shows a small flagellum at their tip, which is better seen when the ascus is ruptured.. Direct microscopic examination
Disease is mainly diagnosed by clinical history and examination. Other method is direct microscopy using KOH solution.Wet mount of the nodules in KOH is confirmatory. There we can see organized brown spores in black piedra invading the hair.Matured nodules will show asci that means sexual spores containing eight ascopore. Each one shows a small flagellum at their tip, which is better seen when the ascus is ruptured..
Culture Sabouraud's dextrose agar is used for culture.Culture from black colored nodule on the Sabouraud's dextrose agar at room temperature will grow small, compact, blackish conical colonies with velvety surface . The reverse side of the colonies also reveals black colonies. When looking at those colonies with microscopy it will show round, dark brown, globus ascus that confirmatory for Piedraia hortae species.. Culture
Sabouraud's dextrose agar is used for culture.Culture from black colored nodule on the Sabouraud's dextrose agar at room temperature will grow small, compact, blackish conical colonies with velvety surface . The reverse side of the colonies also reveals black colonies. When looking at those colonies with microscopy it will show round, dark brown, globus ascus that confirmatory for Piedraia hortae species..

Management - Supportive

Fact Explanation
Avoid moisture, Black piedra tends to grow in moist humidified areas.So that avoidance of moisture is one of the treatment option.. Avoid moisture,
Black piedra tends to grow in moist humidified areas.So that avoidance of moisture is one of the treatment option..
Clipping and shaving the hairs /trichotomy Clipping and shaving of the affected hair is another established treatment . But most women do not prefer that due to cosmetic reasons. ,.The general rule is to carry out trichotomy on affected hair . Clipping and shaving the hairs /trichotomy
Clipping and shaving of the affected hair is another established treatment . But most women do not prefer that due to cosmetic reasons. ,.The general rule is to carry out trichotomy on affected hair .
Remove using fine comb Removal using a fine comb is recommended in cases involving women.. Remove using fine comb
Removal using a fine comb is recommended in cases involving women..
Maintain good hygiene Patients should be counseled regarding good hygiene, avoidance of use of shared combs and clips, discarding or disinfecting underclothes (in genital piedra) in order to prevent recurrences.. Maintain good hygiene
Patients should be counseled regarding good hygiene, avoidance of use of shared combs and clips, discarding or disinfecting underclothes (in genital piedra) in order to prevent recurrences..

Management - Specific

Fact Explanation
Application of terbinafine, tolnaftate and azoles Topical application of high concentration of terbinafine, tolnaftate, azoles and 1 in 2,000 mercury bichloride solution can be carried out.. And topical application of antifungal azole lotions/shampoos are also found to be effective.. Application of terbinafine, tolnaftate and azoles
Topical application of high concentration of terbinafine, tolnaftate, azoles and 1 in 2,000 mercury bichloride solution can be carried out.. And topical application of antifungal azole lotions/shampoos are also found to be effective..
Oral terbinafine and itraconazole In case of resistance to tropical application of anti fungal creams, can change the treatment in to oral terbinafine and itraconazole which has proven to have successful outcomes.. Oral terbinafine and itraconazole
In case of resistance to tropical application of anti fungal creams, can change the treatment in to oral terbinafine and itraconazole which has proven to have successful outcomes..
Use sublimate solution Use sublimate solution 1/1000 or even 1/2000 in 60% alcohol can be carried out.Treatment involves cologne, using the same amount of mercury bichloride, 0.3g of sublimate solution for 300ml of cologne, or 600ml, if the 1/2000 proportion is chosen.. Use sublimate solution
Use sublimate solution 1/1000 or even 1/2000 in 60% alcohol can be carried out.Treatment involves cologne, using the same amount of mercury bichloride, 0.3g of sublimate solution for 300ml of cologne, or 600ml, if the 1/2000 proportion is chosen..
Mercury bichloride or 2% formaldehyde Mercury bichloride 1/1000 or 2% formaldehyde reduce the risk of cutting hair by producing good results.But infection usually recur after treatment.. Mercury bichloride or 2% formaldehyde
Mercury bichloride 1/1000 or 2% formaldehyde reduce the risk of cutting hair by producing good results.But infection usually recur after treatment..

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