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'''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
'''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
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==Diagnosis==
==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===
===Physical Examination===
=====Hair=====
=====Hair=====

Revision as of 20:59, 17 August 2017

White piedra
ICD-10 B36.2
ICD-9 111.2
DiseasesDB 31871
MeSH D010854

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2]

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:

Name of superficial infection Clinical presentation Extension to hair follicle Fungus(i) Systemic disease KOH preparations Morphology in tissue sections
Tinea or ringworm Round lesions with scaly border, accompanied by pruritis and burning Yes; when suppurative known as kerion, when chronic known as Majocchi's granuloma Dermatophytes (Epidermophyton spp., Trichophyton spp., Microsporum spp.) Very rare but can invade the dermis and soft tissues, causing mycetomas Hyphae with or without septations Hyphae cannot be visualized in the keratin with H&E, special stains are needed
Tinea versicolor Hypo and hyperpigmentation in patients with oily and sweaty skin, fine scales when scratching Yes, known as Pityrosporum folliculits Malassezia spp. Systemic infections may occur in premature neonates receiving parenteral nutrition and in other immunosuppressed hosts Yeasts and hyphae (“spaghetti and meat balls”) Faintly basophilic hyphae in the stratum corneum
Tinea nigra Brown to black macule, usually on palms, with some scaling No Phaeoannellomyces werneckii Not described Darkly pigmented, septated, and branching hyphae Pigmented hyphae in the stratum corneum
White piedra Creamy-white, small, soft nodules in hair shafts No Trichosporon spp. Immunosuppressed patients may have lung infiltrates, renal involvement, and fungemia Septate hyphae perpendicular to hair shaft Not used for diagnosis
Black piedra Hard dark nodules in hair shafts No Piedraia hortae Not described Collections of crescent ascospores surrounded by pigmented hyphae Not used for diagnosis
Superficial candidiasis Intertrigo, chronic paronychia, onychodystrophy, cheilitis Yes Candida spp. Yes, particularly in patients with AIDS and depending on the level of immunosuppression Yeasts, pseudohyphae may be observed Fungal elements may be seen through the biopsy, vascular invasion must be determined

Differential diagnoses of annular skin lesions

Disease Clinical presentation Treatment
Tinea corporis Scaly, annular, erythematous plaques or papules on glabrous skin Topical and systemic antifungals
Pityriasis rosea Small, fawn-colored, oval patches with fine scales along the borders, following skin cleavage lines Topical and systemic corticosteroids; UVA, UVB
Granuloma annulare Indurated, nonscaly, skin-colored annular plaques and papules, usually on the extremities Topical and intralesional corticosteroids
Sarcoidosis Indurated, erythematous plaques Topical, intralesional and systemic corticosteroids; antimalarials; thalidomide
Hansen's disease Erythematous annular plaques, with or without scale Dapsone; rifampin (Rifadin)
Urticaria Evanescent annular, nonscaly, erythematous plaques Oral antihistamines
Subacute cutaneous lupus erythematosus Annular or papulosquamous plaques, with or without scales, on sun-exposed areas Topical, intralesional and systemic corticosteroids; antimalarials
Erythema annulare centrifugum Annular patches with trailing scales inside erythematous borders Topical and systemic corticosteroids; oral antihistamines; treatment of the underlying cause

Physical Examination

Hair

External links

Template:Disease-stub Template:Mycoses

  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 "Dermatology Atlas".
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