Black Piedra

Clinical Manifestations.

According to Iranian Association Of  Clinical Laboratory Doctors, clinical manifestations include :

   - Affected hairs: from 4 to 8 firmly attached nodules (d: 1-2 mm).

-          - Nodules: oval or elongated, hard, dark brown to black , many surround the hair.

-          - Uncovered part of the hair shafts.

-          - Often broken hairs. 

         Treatment.

According to Iranian Association Of  Clinical Laboratory Doctors, there are different treatments of Black Piedra:

-          - Clipping the hairs.

-          - Using a topical salicylic acid preparation.

-          - Using a topical imidazole cream.                                                                                                         

        -  Application of topical selenium sulphide 

     

          Clinical Cases.

          1-First Case.

James Marshall, M.D ( 1961) noted a case in a four-year-old white girl. The hair had fallen out in patches and there was little scalp hair. The girl's scalp hair was short, coarse, dry, dull and sparse. At the back of the head, the hairs were about 1 cm in length, in front about 5 cm. Also,  studies showed small black, hard nodules containing dark, branching hyphae resembling arthrospores and small asci with several fusiform ascospores. The infection was treated  with 10% potassium hydroxide for 10 - 15 minutes. Also, the nodule was composed of closely septate. The fungus was isolated both microscopically and in cultural. As a result,  the fungus was identified as Piedraia hortai. (Figure3)

Figure 3: girl's hair has black piedra

2-Second case.

            According to the British Journal of Dermatology (1994)  a 23-year-old man had typical clinical signs of black piedra on his scalp after his return from India. There were black nodules around the hair shafts. Also, the crushed nodules revealed numerous asci and ascospores on microscopy. He was treated with oral terbinafine 250 mg daily for 6 weeks.  (1)

References

1-   British Journal of Dermatology. (1994, Apr). Black piedra: the first case treated with terbinafine (lamisil). US National Library of Medicine National Institutes of Health. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/8186138

2-      Marshall James  (1961). Black piedra in a child with pili torti, bamboo hair ad cogenital ichthyosiform erythroderma.. Retrieved from http://archive.samj.org.za/1961 VOL XXXV Jan-Jun/Articles/03 March/3.1

3-      Fonseca. , & de Area Leao, (1928). Piedraia spp. Doctor Fungus . Retrieved from http://www.doctorfungus.org/thefungi/piedraia.php

4-      Zibafar, E. Iranian Association of Clinical Laboratory Doctors. Retrieved from http://www.iacld.ir/DL/modavan/mycology/92/piedra&tineanigradrzibafar.pdf

5-      Figueras, M. J., & Guarro, J. Ultrastructural aspect of the keratinolytic activity of piedra. . Retrieved from http://www.dermatophytes.reviberoammicol.com/p136141.pdf

6-      Richardson, M. D., & Warnock, D. W. Fungal infection. Retrieved from http://books.google.com/books?id=TLhI9NjABuYC&pg=PT176&lpg=PT176&dq=Habitat of Piedraia hortae&source=bl&ots=nEAUYUGd1X&sig=bDtt23winKZ3ycCN7IfWAQTG0EU&hl=ar&sa=X&ei=gCE5U8jNJJDlqAGQ7IHAAw&ved=0CEUQ6AEwAw

7-      mycology online. (n.d.). Retrieved from http://www.mycology.adelaide.edu.au/Mycoses/Superficial/Black_piedra/

8-      wisegeek clear answers for common questions. (n.d.). Retrieved from http://www.wisegeek.com/what-is-piedra.htm

Schwartz, R. A. (2013, 9 26). Piedra. Medscape. Retrieved from http://emedicine.medscape.com/article/1092330-overview