Review Article White Piedra: Review of 131 cases.

This study analyzes the clinical characteristics of patients diagnosed with White Piedra through a systematic review of cases in the literature. A sample of 131 subjects was considered, of which 91.6% were female and most were 18 years of age or younger. Most studies were conducted in Brazil, followed by India, and Mexico. The most common etiologic agent found was Trichosporon spp (34.3%). Most affected patients were asymptomatic (94.6%) and predisposing factors included long hair, use of a hair band or hair accessories, and wet hair. The most common clinical feature was the presence of nodules. The evaluation of treatment effectiveness was hindered by the scarcity of follow-up information in the majority of the studies. It is concluded that White Piedra infection is more common in young women and is associated with hair-related factors.

White piedra, black piedra, tinea versicolor, and tinea nigra: contribution to the diagnosis of superficial mycosis.

Superficial mycoses are fungal infections restricted to the stratum corneum and to the hair shafts, with no penetration in the epidermis; they are: white piedra, black piedra, tinea versicolor, and tinea nigra. This study presents images of mycological tests performed in the laboratory, as well as exams performed at the authors office, in order to improve the dermatologist's knowledge about the diagnosis of these dermatoses, which are common in many countries.

White piedra, black piedra, tinea versicolor, and tinea nigra: contribution to the diagnosis of superficial mycosis

Abstract Superficial mycoses are fungal infections restricted to the stratum corneum and to the hair shafts, with no penetration in the epidermis; they are: white piedra, black piedra, tinea versicolor, and tinea nigra. This study presents images of mycological tests performed in the laboratory, as well as exams performed at the authors office, in order to improve the dermatologist's knowledge about the diagnosis of these dermatoses, which are common in many countries.

Tricomicosis axilar: diagnóstico en imágenes, clínica, luz de Wood y dermatoscopia / Trichomycosis axillaris: clinical, Wood lamp, and dermoscopic diagnostic images

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Long-term pubic dermatitis diagnosed as white piedra.

The case of a 58-year-old man with a pruritic rash involving the pubic area that had been undiagnosed for 30 years is presented. At least 15 different primary care physicians and dermatologists evaluated the patient during this time period. Multiple treatments were unsuccessful and a definitive diagnosis was not rendered. Wood lamp evaluation of the pubic area revealed hair shaft concretions that were confirmed on histologic evaluation to be white piedra (WP). The patient was successfully treated with topical ketoconazole and the eruption completely resolved. Our case raises awareness of the use of Wood lamp and dermoscopy to evaluate for parasitic infections of the pubic hair shafts when nonspecific dermatitis presents in this area.

Tricomicosis axilar / Trichomycosis axillaris

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Experimental white piedra: a robust approach to ultrastructural analysis, scanning electron microscopy and etiological discoveries.

White piedra is a fungal infection characterized by nodules comprised of Trichosporon species and restricted to the extrafollicular portion of the hair shaft. The diagnosis is based on clinical and mycological characteristics, and must be confirmed with a precise identification of the etiological agent. This research aimed to develop an in vitro infection model of white piedra and analyze its morphological and ultra-structural aspects. In the process, hair infection was induced using eight isolates of the genus Trichosporon maintained in the Culture Collection Micoteca URM. The ITS and IGS1 regions were sequenced for taxonomic confirmation. Scanning Electron Microscope (SEM) was performed at the Strategic Center for Northeast Technologies (CETENE). The scanning electron microscope was equipped with an Energy Dispersion Spectrometer (EDS). The Trichosporon isolates were identified as Trichosporon asahii (6) and Trichosporon montevideense (2) by internal transcript spacer (ITS) region and intergenic spacer 1 region (IGS1) sequencing. All eight strains were used to induce the in vitro hair infection, and nodules formed after the incubation period. Temperature variations and high humidity were not observed to be related to the development of this hair disease. The main chemical constituents detected in the nodules were carbon, nitrogen and oxygen, as well as a low level of sulfur. The absence of calcium, combined with the low level of sulfur, might explain the soft nature of the white piedra nodules. This study demonstrated that several Trichosporon species may be responsible for causing white piedra.

Piedra blanca axilar / Axilar white piedra

La verrugosis generalizada es un rasgo común a diferentes síndromes de inmunodeficiencia, cuyo prototipo es la epidermodisplasia verruciforme (EV). Se presenta una paciente con síndrome WILD (Warts, Immunodeficiency, Lymphoedema, anogenital Dysplasia), que consultó por verrugas profusas, con displasia genital y linfedema. La presencia de DNA para los papilomavirus de los grupos I y II se reveló con hibridización molecular por captura híbrida en microplaca para detección del DNA de HPV de lesiones de cuello uterino. La inmunofenotipificación en sangre periférica demostró población linfoide con moderado aumento de poblaciones NK y TNK, sin evidencia inmunofenotípica de población B clonal. Las verrugas planas mejoraron con retinoides sistémicos e imiquimod tópico. La displasia genital desapareció luego de la vacunación para HPV con vacuna cuadrivalente (AU)

Generalized verrucosis is a common characteristic of several immunodeficiency disorders whose prototype is the epidermodysplasia verruciformis. We report a patient with WILD SYNDROME (Warts, Immunodeficiency, Lymphoedema and anogenital Dysplasia) who consulted for profuse warts, genital dysplasia and limphoedema. The presence of DNA from papillomavirus groups I and II was revealed by molecular hybridization with hybrid capture in microplate for HPV DNA detection of uterine cervical lesions. Immunophenotyping in peripheral blood showed lymphoid population with moderate increase in NK and TNK populations without immunophenotypic evidence of clonal B population. Flat warts improved with systemic retinoids and topical imiquimod. The genital dysplasia disappeared after vaccination with quadrivalent HPV vaccine (AU)

Trichosporon inkin and Trichosporon mucoides as unusual causes of white piedra of scalp hair.

White piedra of scalp hair is considered a rare entity. We report three cases of this disorder all of whom presented with nodules on the hair. Potassium hydroxide preparations of the hair revealed clustered arthrospores and mature, easily detachable nodules. Cultures grew Trichosporon inkin in 2 patients and Trichosporon mucoides in one patient. Both these fungi are unusual causes of white piedra.

Trichosporon inkin: an uncommon agent of scalp white piedra. Report of four cases in Brazilian children.

We report four cases of scalp white piedra (SWP) in Brazilian female children. Morphological and physiological approaches gave inconsistent results for identifying Trichosporon to species level, while the sequencing of the intergenic spacer 1 region of ribosomal DNA accurately identified the agent of SWP as T. inkin. These cases emphasize the occurrence of this species causing this type of infection. The molecular identification of the suspected agent is needed for appropriate epidemiological surveillance of superficial mycoses caused by Trichosporon species.

White piedra: molecular identification of Trichosporon inkin in members of the same family.

INTRODUCTION: White piedra is a superficial mycosis caused by the genus Trichosporon and characterized by nodules on hair shaft. METHODS: The authors report a family referred to as pediculosis. Mycological culture on Mycosel® plus molecular identification was performed to precisely identify the etiology. RESULTS: A Trichosporon spp. infection was revealed. The molecular procedure identified the agent as Trichosporon inkin. CONCLUSIONS: White piedra and infection caused by T. inkin are rarely reported in Southern Brazil. The molecular tools are essentials on identifying the Trichosporon species.

White piedra: molecular identification of Trichosporon inkin in members of the same family / Piedra branca: identificação molecular do Trichosporon inkin em membros de mesma família

INTRODUCTION: White piedra is a superficial mycosis caused by the genus Trichosporon and characterized by nodules on hair shaft. METHODS: The authors report a family referred to as pediculosis. Mycological culture on Mycosel® plus molecular identification was performed to precisely identify the etiology. RESULTS: A Trichosporon spp. infection was revealed. The molecular procedure identified the agent as Trichosporon inkin. CONCLUSIONS: White piedra and infection caused by T. inkin are rarely reported in Southern Brazil. The molecular tools are essentials on identifying the Trichosporon species.

INTRODUÇÃO: Piedra branca é micose superficial causada por fungos do gênero Trichosporon e caracterizado por nódulos firmemente aderidos à haste do pêlo. MÉTODOS: Os autores relatam casos familiares encaminhados como pediculose. Foram utilizados cultura em ágar Mycosel® e identificação molecular. RESULTADOS: Exame micológico revelou a infecção por Trichosporon spp. A identificação molecular demonstrou se tratar do Trichosporon inkin. CONCLUSÕES: Piedra branca e infecção pelo T. inkin são raramente relatados na região sudeste do Brasil. A identificação molecular é essencial para correta determinação de espécies no gênero Trichosporon.

Extensive white piedra of the scalp caused by Trichosporon inkin: A case report and review of literature.

Trichosporon species cause wide varieties of fungal infections. White piedra, a superficial fungal infection on the hair shaft, is caused by Trichosporon species. We report here a case of white piedra over the scalp due to T. inkin, a rarely isolated pathogen from such a lesion. The identification of the fungus was confirmed on the basis of morphology, carbohydrate assimilation tests, and sequencing of the ITS region of rDNA. The available literature on infections due to T. inkin is also reviewed.

White piedra of scalp hair by Trichosporon inkin.

White piedra is a rare fungal infection of hair and is reported to be all the more rare on scalp. Trichosporon inkin is usually associated with white piedra of pubic hair. We report a case of white piedra of scalp hair caused by T. inkin. This is the first case reported from India and the fifth case reported worldwide. A 50-year-old Muslim female presented with white knots over scalp hair. Diagnosis of Trichosporon was made by examining KOH mounts of epilated hair and Lactophenol Cotton Blue preparations of the growth in culture. Automated mini-API test (for biochemical profiles) and Electronmicroscopy studies (for cell wall structures) helped in identification of the species. Mini-API test was also positive for Cryptococcus curvatus which could be due to similarity in biochemical and physiological properties of the two species. Absence of C. curvatus on culture further supports this view. Topical antifungal therapy resulted in clinical clearance within 2 months. Higher incidence of scalp white piedra is observed in Muslim females; contributing factor being the custom of using a veil, leading to higher humidity and limited sunlight exposure.