Introduction
Healthy hair reflects the well-being of an individual. How one takes care of their hair speaks volumes about one’s personality. Hair plays a significant role in one’s appearance, self-confidence, and personal expression. Although everyone's hair is unique, maintaining its health is important. However, just like any other part of the body, hair too is susceptible to various conditions and diseases that can affect its health and vitality. One such condition is piedra disease.
What Is Piedra Disease?
Piedra disease, also known as trichomycosis nodularis or trichomycosis nodosa, is a relatively rare fungal infection that affects the visible-outside part of the hair strand, the hair shaft. It is characterized by the development of small hard stone-like nodules along the hair fibers. Piedra disease can occur in individuals of any age, however, the incidence was shown to be lesser after middle age.
What Causes Piedra Disease?
Fungus, specifically trichosporon species and Piedraia hortae, is the causative factor of piedra disease. These fungal species thrive in tropical and subtropical regions (such as Asia, South America, and Africa), which have warm and humid environments. Some of the factors that may contribute to developing piedra disease may include:
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Living in unsanitary conditions.
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Sharing hair combs or accessories.
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Using excess hair oils.
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Maintaining poor hygiene.
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Wearing tight hats or veils.
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Long poorly maintained hair.
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Preexisting fungal infections.
How one can get piedra disease is not well understood; however, it is believed to be transmitted through direct contact with surfaces contaminated by the fungus (for example, hair accessories), and it affects hair shafts, resulting in the formation of stone-like nodules. Cases of black piedra have also been reported to have occurred through sexual transmission.
What Are the Types of Piedra Disease?
There are two main types of piedra disease:
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White Piedra - It is caused by various fungal species of trichosporon. It leads to the formation of soft, white, or cream-colored nodules or bumps on the hair shafts. These nodules are commonly found in the hair or the scalp, beard, mustache, and pubic region.
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Black Piedra - It is caused by the Piedraia hortae fungi. It leads to the formation of hard, black, or dark brown nodules or masses on the hair shaft, primarily affecting the scalp hair.
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Mixed Piedra - It is an extremely uncommon condition that is characterized by a distinct clinical representation where the hair exhibits a spangled (sparkly) appearance. This unique appearance is caused by the simultaneous presence of both white and black colored nodules on the hair shaft.
What Are the Symptoms of Piedra Disease?
The symptoms of piedra disease depend on the type of piedra.
Symptoms of White Piedra Disease Include:
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Soft, white, or cream-colored nodules or bumps on hair shafts that are less than half an inch in size.
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Affected areas commonly include scalp hair, beard, mustache, and pubic region.
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Nodules may be easily movable along the hair shaft.
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Fungus grows within the hair shaft and outside of it, causing hair to be weak and brittle.
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Hair is gritty on touch.
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Discomfort or itching in the affected area.
Symptoms of Black Piedra Disease Include:
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Hard, black, or dark brown nodules on the hair shafts that are less than half an inch in size.
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Primarily affects the scalp hair.
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Nodules are firmly attached to the hair shaft and cannot be easily moved.
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The fungus growing in the subcuticular region can cause the hair cuticle (protective layer of the hair) to rupture, consequently causing weak and brittle hair.
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Hair is gritty on touch.
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Rarely causes itching in the affected area.
How to Diagnose Piedra Disease?
In order to diagnose piedra disease, various diagnostic methods can be used. Some are as follows:
Physical Examination - The doctor will examine the affected hair (scalp hair or hair of the other body parts) for the presence of nodules and the characteristic texture and color. Doctors may also examine if the nodules can be moved on the hair shaft (white piedra disease) or if it is adherent to the hair shaft (black piedra disease).
Trichoscopy - This procedure involves using a highly magnifiable, specialized microscope that can help visualize the color of the nodule, hair texture, the area involved, and the attachment to the hair shaft.
Direct Microscopic Examination (DME) - DME involves crushing the nodules and examining them under a microscope with ten percent potassium hydroxide.
Culture Test - Culturing the fungal organisms from the affected hairs on Sabouraud dextrose agar (SDA) medium at room temperature is another diagnostic method.
How Is Piedra Disease Treated?
Piedra disease is primarily treated with oral or topical antifungal medications. Common treatment options for piedra disease include:
Topical Antifungal Medications - For mild cases, topical antifungal creams and lotions containing antifungal agents like two percent of Ketoconazole or Ciclopirox are prescribed. These creams are generally applied to the affected area for a specific time period in order to allow the proper absorption of the medication and then may be rinsed off. Antifungal shampoos containing two percent of Miconazole may also be advised for washing the hair.
Oral Antifungal Medications - In more severe or widespread cases, oral antifungal medications may be prescribed. Medications such as Itraconazole, Fluconazole, or Terbinafine 250mg once a day for six weeks may be prescribed to help eliminate the fungus associated with piedra disease from the body.
Shaving the Hair - If topical and oral antifungal medications do not seem to give relief from piedra disease or if the condition has worsened, then one is advised to shave the affected hair as a last resort. However, women affected with piedra disease may not accept this treatment option if the hair affected is that of the head for aesthetic reasons or moral values.
Proper Hygiene Practices - Especially while on treatment, individuals are advised to maintain good hygiene for the medications to work as well as to avoid the recurrence of the disease.
How to Prevent Piedra Disease?
In order to prevent the occurrence or reoccurrence of piedra disease:
Maintain and follow good hygiene by regularly washing and thoroughly drying the hair and other affected areas of the body.
Avoid sharing personal items such as combs, hats, or similar hair accessories.
Choose loose-fitting and breathable clothing in areas with a warm and humid climate.
Have a well-balanced-nutritious diet. Exercise, sleep, and manage stress for overall well-being.
Conclusion
Piedra disease is uncommon and does not progress to cause any significant negative impact on the health of the individual. However, if one notices a change in hair texture and visible specks of white or black color on the hair, it is advised to get a consult at the earliest to get appropriate treatment and avoid the scenario of having to shave the hair. By maintaining proper hygiene and taking basic preventive measures, this uncommon disease can be effectively prevented.
