White Piedra: An Uncommon Superficial Fungal Infection of Hair

Abstract

White piedra is a superficial fungal infection of hair caused by <i>Trichosporon</i> species. It presents clinically as white nodules encasing the hair shafts and may lead to increased fragility. It can usually be differentiated easily from clinically similar conditions based on clinical and microbiologic features. We report a case of white piedra of scalp hair in a 32-year-old female caused by <i>T. ovoides</i>, diagnosed using clinical, trichoscopic, microbiologic and molecular methods. In this case, trichoscopy acted as an interface between clinical and microbiologic examination, obviating the need for hair shaft microscopy. The genus <i>Trichosporon</i> contains 6 species of clinical significance viz., <i>T. asahii, T. asteroides, T. cutaneum, T. inkin, T. mucoides</i>, and <i>T. ovoides</i>, which cannot be differentiated based on their morphologic characteristics. A genotypic identification using molecular methods helped determine the causative species. It was treated successfully with oral itraconazole and topical ketoconazole.