Piedra is a fungal disease that causes hair breakage. It has two types, black and white, caused by different fungi. Treatment involves shaving the hair or using antifungal agents. Recurrence is rare, and prognosis is generally good.
La piedra is a disease that involves the attachment of fungi on the hair shaft, which leads to breakage of the hair itself. It takes its name from the Spanish word for “stone”. Piedra is also referred to as trichosporosis, as the fungal genus Trichosporon is cited as the cause of this condition. Several other types of mushrooms, however, contribute to the piedra’s appearance. The condition is thought to have first been described in the mid-19th century publication The Human Hair: Its Structure, Growth, Diseases, and Their Treatment.
In the early 20th century, piedra had been classified into two types: black piedra and white piedra. The black form is characterized by the weakening of the hair shaft caused by the Piedraia hortae fungus. It usually affects the hair on the scalp and is more common in South America and Southeast Asia, particularly in regions with high humidity and high temperatures. This version of the condition gets its name from the dark pigmentation that the nodules have.
Similarly, the white variant gets its name from the light or cream-colored complexion of the lumps that characterize it. In some cases, however, it may have a brownish pigmentation. Unlike the black piedra, it is quite common in the United States, particularly in the southern region. It is also common in South America and Asia, as well as parts of Europe and Japan. The main sites of occurrence include beards and mustaches, eyebrows, eyelashes, and hair in the genital area and underarms.
It is the white piedra caused by the Trichosporon fungus. This genus is divided into six species: Trichosporon asahii, Trichosporon asteroids, Trichosporon cutaneum, Trichosporon inkin, Trichosporon mucoides and Trichosporon ovoides. In addition to humans, white piedra affects monkeys and horses; in contrast, the black variant is restricted to humans and apes.
The most popular and effective form of piedra treatment is shaving the patient’s hair. Some people, however, opt for antifungal agents or medicines. Terbinafine, under the trade names Lamisil and Terbinex, is most commonly used to treat fungal infections of the toenails and fingernails and is the preferred antifungal method for the black version. Antifungal agents used against the white variant include ciclopirox olamine, also known as Mycoster, Batrafen and Loprox; and derived from the organic compound imidazole.
People receiving treatment for piedra may experience destruction of the structure of the hair shaft. Compounding this complication is the possibility of recurrence, which could be spontaneous and unexpected. Despite this, doctors generally consider the prognosis to be good after treatment of the condition, especially given that recurrence is rare.
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