Trichoscopy a key in diagnosing white piedra in hair

Daniela Guzmán-Sanchez, MD

Daniela Guzmán-Sanchez, MD

White piedra is a superficial mycosis that affects the hair shaft, but it can be efficiently diagnosed using trichoscopy, which is dermoscopic imaging of the scalp and hair.

“Dermoscopy/trichoscopy is a fast, non-invasive, and cost-efficient technique for the diagnosis of hair disorders,” said Daniela Guzmán-Sanchez, MD, a dermatologist at the University of Guadalajara, Mexico, and a research fellow studying hair disorders and cosmetic dermatology at Wake Forest University, North Carolina.

White piedra is caused by yeast-like organisms of the genus Trichosporon. In her March 7 presentation, “Dermoscopy Pearls: Piedra,” part of “Hair and Scalp Dermoscopy” (S061), Dr. Guzmán-Sanchez said it commonly affects the shaft of the hair of the beard, moustache, genitals, axilla, and scalp — although patients are asymptomatic.

Those most affected by the organisms live in Mexico, and children are especially susceptible. Risk factors for the condition are humidity, braids, and high temperatures, she said.

Besides the use of trichoscopy, diagnosis of white piedra also may include a clinical exam and mycological studies, such as direct observation and isolation of the fungi. Dr. Guzmán-Sanchez shared a diagnostic tip that fusiform and yellow nodules of Trichosporon form around the hair shaft and are attached to the distal parts of the hair.

Dr. Guzmán-Sanchez concluded by adding, “Mycological exams should always be performed to confirm the diagnosis.”

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