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Year : 1990  |  Volume : 56  |  Issue : 1  |  Page : 56-57

White piedera in Delhi

Correspondence Address:
J S Pasricha

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A 19 year old girl developed asymptomatic, hard, yellowish, 1-2 mm nodules adhering to the shafts of her scalp hairs. Microscopic examination of a nodule in 10% KOH re a greenish-tinged mycelium, with arthrovo and blastopores. Culture of the hair on Sabouraud's deidrose agar medium r Trichosporon beigelii.Treatment with 1% clotrimazale aidplied oA the h.aris once a day led to disappearance of the nodules in 4 weeks. is our second case of piedra from a non-endemic area.

Keywords: Piedra, White, Non-endemic area

How to cite this article:
Pasricha J S, Nigam P K, Banerjee U. White piedera in Delhi. Indian J Dermatol Venereol Leprol 1990;56:56-7

How to cite this URL:
Pasricha J S, Nigam P K, Banerjee U. White piedera in Delhi. Indian J Dermatol Venereol Leprol [serial online] 1990 [cited 2021 Jan 22];56:56-7. Available from:

Piedra is rare in the north Indian states, while it is common in Kerala.[1] Isolated cases of white piedra have been reported from Bombay,[1] Madras[2],[3] and Calcutta[4],[5] while black piedra has been reported from Varanasi,[6] Bombay[1] and Delhi.[7] Recently, we saw a patient having white piedra.

  Case Report Top

A 19-year-old girl developed multiple, small, yellowish, nodules on a localized area of her scalp hairs during the last 3 months. The lesions were asymptomatic, and limited to the area underneath the knot of her hair. She was born and educated in Delhi and had never visited Kerala. Neither did she have keralite friends. She had never used a shampoo, but for the last 3 months she had been cleaning her hair once a week with an extract of dried berry leaves, prepared by boiling approximately 250 gm of leaves in a litre of water. She also used to apply mustard oil on her hair before washing and was in the habit of tying her scalp hair when these were still wet. She had never been to a barber or a beautician for her hair dressing. She was otherwise quite healthy and none of her family members and friends had a similar affection. The nodules were friable and could be easily crushed between the slides. Direct microscopic examination of the nodule in 10% KOH revealed [Figure - 1] a transparent, green-tinged mycelial mass along with arthrospores and blastospores. Asci were not seen. Culture on Sabouraud's dextrose agar medium yielded Trichosporon beigelii (T. cutaneum) within 4 days. The colony was cream-coloured, yeast-like, with a wrinkled surface and adherent to the surface of the medium. A mount of the colony revealed myce­lium, pseudo mycelium, arthrospores and blastospores. For treatment she was advised to use an ordinary shampoo for her hair once a week, to stop using berry leaves extract and mustard oil, and to apply 1 % clotrimazole lotion once a day on the scalp hairs. Within 4 weeks, the nodules disappeared from her hair.

  Comments Top

Occurrence of an endemic disease in a non­endemic area can be due to the following reason (s) : (1) the patient having visited the endemic area, (2) the patient having had reasonably intimate contact with other persons coming from the endemic area, (3) using contaminated materials brought from the endemic area, or (4) presence of an unrecognised focus in the so­called non-endemic area.

Our patient had neither herself gone to Kerala, nor had friends from that region to account for her infection. Like the previous patient, this patient also had wrong notions about the hair hygiene, and was using home­made cleaning agents prepared from wild vegetation. T. beigelii usually infects the mar and horse and occasionally monkeys, but it is likely to have contaminated the materials used by our patient for washing her hair. Boiling the water for making the extract is expected to have destroyed the fungus but it is possible that the boiling was inadequate which spared at lease some spores of the fungus. The habit of tying the hair while these were still wet would provide enough moisture and heat for the growth of the fungus in our patient.

We attempted to grow the fungus from an aqueous extract of the ingredients of the home­made hair washing material but a profuse over­growth of saprophytic fungi, frustrated our attempt to detect the source of infection in our case.

  References Top

1.Marquis L : Fungi, fragile, fastidious, fascinating (CME), Ind J Dermatol Venereol Leprol, 1986; 52 251-261.  Back to cited text no. 1    
2.Kamalam A and Thambiah AS : A study of 3891 cases of mycoses in the tropics, Sabouraudia, 1976; 14 : 129.  Back to cited text no. 2    
3.Pankajalaxmi VV, Taralaxmi VV, Paramasivan CN et al : Trichosporon beigelli infection in Tamil Nadu, Ind J Dermatol Venereol Leprol, 1979; 45 :136-138.  Back to cited text no. 3    
4.Basu N, Sanyal M and Banerjee AK et al : White piedra in India, Ind J Dermatol Venereol, 1970; 36 : 154-155.  Back to cited text no. 4    
5.Thammayya A and Sanyal M : White piedra, Mycotic infection of the hair, Ind J Med Res, 1976; 64 : 554.  Back to cited text no. 5    
6.Vashistha LK : Black piedra, Ind J Dermatol Venereol Leprol, 1980; 46 :315-317.  Back to cited text no. 6    
7.Pasricha JS, Seetharam KA and Thanzama J Piedra in a north Indian woman, Ind J Dermatol Venereol Leprol, 1988; 54 : 272-273.  Back to cited text no. 7    


[Figure - 1]

This article has been cited by
1 Two cases of scalp white piedra caused by Trichosporon ovoides
Tambe, S.A., Dhurat, S.R., Kumar, C.A., Thakare, P., Lade, N., Jerajani, H., Mathur, M.
Indian Journal of Dermatology, Venereology and Leprology. 2009; 75(3): 293-295
2 Itraconazole therapy for white piedra affecting scalp hair
Khandpur, S., Reddy, B.S.
Journal of the American Academy of Dermatology. 2002; 47(3): 415-418


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