View source for White piedra

{{Infobox_Disease |
  Name           = {{PAGENAME}} |
  Image          = |
  Caption        = |
  DiseasesDB     = 31871 |
  ICD10          = {{ICD10|B|36|2|b|35}} |
  ICD9           = {{ICD9|111.2}} |
  ICDO           = |
  OMIM           = |
  MedlinePlus    = |
  eMedicineSubj  = |
  eMedicineTopic = |
  MeshID         = D010854 |
}}
__NOTOC__
{{CMG}}; {{AE}} {{KS}}
==Overview==

'''White piedra''' (or '''tinea blanca''') is a [[mycosis]] of the hair associated with [[Trichosporon beigelii]] and is characterized by nodules composed of hyphae that encompass hair shaft
.
==Differential Diagnosis==
White piedra should be differentiated from other diseases presenting as red, [[pruritic]], annular, scaly rash. The differentials include the following:  
{| class="wikitable"
! align="center" style="background: #4479BA; color: #FFFFFF; " |Name of superficial infection
! align="center" style="background: #4479BA; color: #FFFFFF; " |Clinical presentation
! align="center" style="background: #4479BA; color: #FFFFFF; " |Extension to hair follicle
! align="center" style="background: #4479BA; color: #FFFFFF; " |Fungus(i)
! align="center" style="background: #4479BA; color: #FFFFFF; " |Systemic disease
! align="center" style="background: #4479BA; color: #FFFFFF; " |KOH preparations
! align="center" style="background: #4479BA; color: #FFFFFF; " |Morphology in tissue sections
|-
| colspan="1" rowspan="1" |Tinea or [[Ringworm Infection|ringworm]]
| colspan="1" rowspan="1" |Round lesions with [[Scaling skin|scaly]] border, accompanied by [[pruritis]] and burning
| colspan="1" rowspan="1" |Yes; when [[suppurative]] known as [[kerion]], when chronic known as [[Majocchi's granuloma]]
| colspan="1" rowspan="1" |Dermatophytes (''[[Epidermophyton]]'' spp., ''[[Trichophyton]]'' spp., ''[[Microsporum]]'' spp.)
| colspan="1" rowspan="1" |Very rare but can invade the [[dermis]] and [[Soft tissue|soft tissues]], causing [[Mycetoma|mycetomas]]
| colspan="1" rowspan="1" |[[Hyphae]] with or without septations
| colspan="1" rowspan="1" |[[Hyphae]] cannot be visualized in the [[keratin]] with [[H&E stain|H&E]], special stains are needed
|-
| colspan="1" rowspan="1" |[[Tinea versicolor]]
| colspan="1" rowspan="1" |Hypo and [[hyperpigmentation]] in patients with oily and sweaty skin, fine [[Scaling skin|scales]] when scratching
| colspan="1" rowspan="1" |Yes, known as ''Pityrosporum'' folliculits
| colspan="1" rowspan="1" |''[[Malassezia]]'' spp.
| colspan="1" rowspan="1" |Systemic infections may occur in [[Premature birth|premature]] [[neonates]] receiving [[parenteral]] nutrition and in other [[Immunosuppression|immunosuppressed]] [[Host (biology)|hosts]]
| colspan="1" rowspan="1" |[[Yeast|Yeasts]] and [[hyphae]] (“spaghetti and meat balls”)
| colspan="1" rowspan="1" |Faintly [[basophilic]] hyphae in the [[stratum corneum]]
|-
| colspan="1" rowspan="1" |[[Tinea nigra]]
| colspan="1" rowspan="1" |Brown to black [[macule]], usually on palms, with some scaling
| colspan="1" rowspan="1" |No
| colspan="1" rowspan="1" |''Phaeoannellomyces werneckii''
| colspan="1" rowspan="1" |Not described
| colspan="1" rowspan="1" |Darkly pigmented, septated, and branching [[hyphae]]
| colspan="1" rowspan="1" |Pigmented [[hyphae]] in the [[stratum corneum]]
|-
| colspan="1" rowspan="1" |[[White piedra]]
| colspan="1" rowspan="1" |Creamy-white, small, soft nodules in hair shafts
| colspan="1" rowspan="1" |No
| colspan="1" rowspan="1" |''[[Trichosporon]]'' spp.
| colspan="1" rowspan="1" |[[Immunosuppressed]] patients may have [[lung]] infiltrates, [[renal]] involvement, and [[fungemia]]
| colspan="1" rowspan="1" |Septate [[hyphae]] perpendicular to hair shaft
| colspan="1" rowspan="1" |Not used for diagnosis
|-
| colspan="1" rowspan="1" |[[Black piedra]]
| colspan="1" rowspan="1" |Hard dark nodules in hair shafts
| colspan="1" rowspan="1" |No
| colspan="1" rowspan="1" |''Piedraia hortae''
| colspan="1" rowspan="1" |Not described
| colspan="1" rowspan="1" |Collections of crescent ascospores surrounded by [[Pigmented lesions|pigmented]] [[hyphae]]
| colspan="1" rowspan="1" |Not used for diagnosis
|-
| colspan="1" rowspan="1" |[[Candidiasis|Superficial candidiasis]]
| colspan="1" rowspan="1" |[[Intertrigo]], chronic [[paronychia]], [[onychodystrophy]], [[cheilitis]]
| colspan="1" rowspan="1" |Yes
| colspan="1" rowspan="1" |''[[Candida]]'' spp.
| colspan="1" rowspan="1" |Yes, particularly in patients with [[AIDS]] and depending on the level of [[immunosuppression]]
| colspan="1" rowspan="1" |[[Yeast|Yeasts]], pseudohyphae may be observed
| colspan="1" rowspan="1" |[[Fungal]] elements may be seen through the biopsy, vascular invasion must be determined
|}

=== Differential diagnoses of annular skin lesions ===
{| class="wikitable"
! align="center" style="background: #4479BA; color: #FFFFFF; " |Disease
! align="center" style="background: #4479BA; color: #FFFFFF; " |Clinical presentation
! align="center" style="background: #4479BA; color: #FFFFFF; " |Treatment
|-
| colspan="1" rowspan="1" |[[Tinea corporis]]
| colspan="1" rowspan="1" |[[Scaling skin|Scaly]], annular, [[erythematous]] [[plaques]] or [[papules]] on [[glabrous skin]]
| colspan="1" rowspan="1" |[[Topical]] and systemic [[antifungals]]
|-
| colspan="1" rowspan="1" |[[Pityriasis rosea]]
| colspan="1" rowspan="1" |Small, fawn-colored, oval patches with fine [[Scaling skin|scale]]s along the borders, following skin cleavage lines
| colspan="1" rowspan="1" |[[Topical]] and systemic [[corticosteroids]]; [[UVA]], [[UVB]]
|-
| colspan="1" rowspan="1" |[[Granuloma annulare]]
| colspan="1" rowspan="1" |[[Induration|Indurated]], nonscaly, skin-colored annular [[plaques]] and [[papules]], usually on the extremities
| colspan="1" rowspan="1" |[[Topical]] and intralesional [[corticosteroids]]
|-
| colspan="1" rowspan="1" |[[Sarcoidosis]]
| colspan="1" rowspan="1" |Indurated, [[erythematous]] [[plaques]]
| colspan="1" rowspan="1" |[[Topical]], intralesional and systemic [[corticosteroids]]; [[antimalarials]]; [[thalidomide]]
|-
| colspan="1" rowspan="1" |[[Hansen's disease]]
| colspan="1" rowspan="1" |[[Erythematous]] annular [[plaques]], with or without [[Scaling skin|scale]]
| colspan="1" rowspan="1" |[[Dapsone]]; [[rifampin]] (Rifadin)
|-
| colspan="1" rowspan="1" |[[Urticaria]]
| colspan="1" rowspan="1" |Evanescent annular, nonscaly, [[erythematous]] [[plaques]]
| colspan="1" rowspan="1" |Oral [[antihistamines]]
|-
| colspan="1" rowspan="1" |[[Subacute cutaneous lupus erythematosus]]
| colspan="1" rowspan="1" |Annular or [[papulosquamous]] [[plaques]], with or without scales, on sun-exposed areas
| colspan="1" rowspan="1" |[[Topical]], intralesional and systemic [[corticosteroids]]; [[antimalarials]]
|-
| colspan="1" rowspan="1" |[[Erythema annulare centrifugum]]
| colspan="1" rowspan="1" |Annular patches with trailing scales inside [[erythematous]] borders
| colspan="1" rowspan="1" |[[Topical]] and systemic [[corticosteroids]]; oral [[antihistamines]]; treatment of the underlying cause
|}
===Physical Examination===
=====Hair=====
<gallery>

Image:Piedra-white01.jpg|Piedra-white. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>

Image:Piedra-white02.jpg|Piedra-white. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>



Image:Piedra-white03.jpg|Piedra-white. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>




Image:Piedra-white04.jpg|Piedra-white. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>


Image:Piedra-white05.jpg|Piedra-white. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>




Image:Piedra-white06.jpg|Piedra-white. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>




Image:Piedra-white07.jpg|Piedra-white. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>






Image:Piedra-white08.jpg|Piedra-white. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>


Image:Piedra-white09.jpg|Piedra-white. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>






Image:Piedra-white10.jpg|Piedra-white. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>


Image:Piedra-white11.jpg|Piedra-white. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>




Image:Piedra-white12.jpg|Piedra-white. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>




Image:Piedra-white13.jpg|Piedra-white. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>





Image:Piedra-white14.jpg|Piedra-white. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>




Image:Piedra-white15.jpg|Piedra-white. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>




Image:Piedra-white16.jpg|Piedra-white. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>




Image:Piedra-white17.jpg|Piedra-white. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>





Image:Piedra-white18.jpg|Piedra-white. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>


</gallery>

==External links==
* [http://www.mycology.adelaide.edu.au/Mycoses/Superficial/White_piedra/ Overview] at [[University of Adelaide]]
* {{DermAtlas|2062238337}}

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{{Mycoses}}
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