scalp white piedra caused by trichosporon asahii · figure 2: dermoscopy of the scalp showing...

Scalp White Piedra caused by Trichosporon asahii Maouni Safae * , Lakhmiri Myriam, Senouci Karima, Meziane Mariam Department of Dermatology, Ibn Sina Hospital, Rabat, Morocco CLINICAL IMAGE A 10-year-old girl presented for asymptomatic whitish particles in the scalp hair since 6 months (Figure 1). It was encircling almost the entirety of the scalp hairs ’ shafts, easily detachable and measuring 1 to 1.5 mm. Scalp skin, eyebrow and eyelash’s hair were normal. Dermoscopy examination showed whitish peripilar casts attached to distal parts of the hair with normal aspect of scalp skin (Figure 2). A detailed interrogation revealed the history of tying wet hairs after washing. Facing the clinical and dermoscopic aspect of the lesions, the diagnosis of white piedra was suggested then confirmed by a mycological examination which revealed a Trichosporon asahii. The patient was advised to keep the hair dry, and was treated with 2% ketoconazole shampoo topically daily for 2 months with oral fluconazole for 3 months. We noted a good evolution and disappearance of the casts after the treatment. Figure 1: Whitish particles in the scalp hair. Figure 2: Dermoscopy of the scalp showing peripilar casts attached to distal parts of the hair (DermLite DL4, 10×). White Piedra (WP) is a rare, asymptomatic, superficial fungal infection caused by yeast-like organisms of the Trichosporon genus. It commonly affects beard hairs shafts, moustache, genitals, axilla and scalp. Human hair colonization may occur as a result of poor personal hygiene, hair washing in stagnant waters, persistence of warmth and moist on the scalp, and excessive use of hair oils. Clinically, WP appears as nodules of variable hardness, which are a compact mass of fungal hyphae and spores that stick to the hair shaft (casts-like) as temperate and tropical climates favor the growth of the causative fungus. Dermoscopy guide the diagnosis by eliminating other defects such as traction hair cast, Trichorrhexis nodosa and Trichorrhexis monilethrix [1]. The treatment is based to local antimycotics, such as 2% zinc pyrithione, imidazoles or selenium sulfur. Oral antifungals are used in second line (Oral itraconazole and fluconazole). The combination of shampoos and oral azole antifungals is strongly recommended [2]. CONFLICT OF INTEREST None. Jo u r n a l o f C l i n i c a l & E x p e r i m e n t al D e r m a t o l o g y R e s ea r c h ISSN: 2155-9554 Journal of Clinical & Experimental Dermatology Research Image Article Correspondence to: Maouni Safae, Department of Dermatology, Ibn Sina Hospital, Rabat, Morocco, Tel: +212635342053; E-mail: [email protected] Received: November 26, 2019; Accepted: December 13, 2019; Published: December 19, 2019 Citation: Safae M, Myriam L, Karima S, Mariam M (2019) Scalp White Piedra caused by Trichosporon asahii. J Clin Exp Dermatol Res. 10:513. DOI: 10.35248/2155-9554.19.10.514 Copyright: © 2019 Safae M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. J Clin Exp Dermatol Res, Vol.10 Iss.6 No:1000514 1

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Scalp White Piedra caused by Trichosporon asahii

Maouni Safae*, Lakhmiri Myriam, Senouci Karima, Meziane Mariam

Department of Dermatology, Ibn Sina Hospital, Rabat, MoroccoCLINICAL IMAGE

A 10-year-old girl presented for asymptomatic whitish particles inthe scalp hair since 6 months (Figure 1). It was encircling almostthe entirety of the scalp hairs ’ shafts, easily detachable andmeasuring 1 to 1.5 mm. Scalp skin, eyebrow and eyelash’s hairwere normal. Dermoscopy examination showed whitish peripilarcasts attached to distal parts of the hair with normal aspect ofscalp skin (Figure 2). A detailed interrogation revealed thehistory of tying wet hairs after washing. Facing the clinical anddermoscopic aspect of the lesions, the diagnosis of white piedrawas suggested then confirmed by a mycological examinationwhich revealed a Trichosporon asahii. The patient was advised tokeep the hair dry, and was treated with 2% ketoconazoleshampoo topically daily for 2 months with oral fluconazole for 3months. We noted a good evolution and disappearance of thecasts after the treatment.

Figure 1: Whitish particles in the scalp hair.

Figure 2: Dermoscopy of the scalp showing peripilar casts attachedto distal parts of the hair (DermLite DL4, 10×).

White Piedra (WP) is a rare, asymptomatic, superficial fungalinfection caused by yeast-like organisms of the Trichosporongenus. It commonly affects beard hairs shafts, moustache,genitals, axilla and scalp. Human hair colonization may occur asa result of poor personal hygiene, hair washing in stagnantwaters, persistence of warmth and moist on the scalp, andexcessive use of hair oils. Clinically, WP appears as nodules ofvariable hardness, which are a compact mass of fungal hyphaeand spores that stick to the hair shaft (casts-like) as temperateand tropical climates favor the growth of the causative fungus.Dermoscopy guide the diagnosis by eliminating other defectssuch as traction hair cast, Trichorrhexis nodosa and Trichorrhexismonilethrix [1]. The treatment is based to local antimycotics, suchas 2% zinc pyrithione, imidazoles or selenium sulfur. Oralantifungals are used in second line (Oral itraconazole andfluconazole). The combination of shampoos and oral azoleantifungals is strongly recommended [2].

CONFLICT OF INTEREST

None.

Journal of

Clin

ical &

Experimental Dermatology Research

ISSN: 2155-9554

Journal of Clinical & ExperimentalDermatology Research Image Article

Correspondence to: Maouni Safae, Department of Dermatology, Ibn Sina Hospital, Rabat, Morocco, Tel: +212635342053; E-mail:[email protected]

Received: November 26, 2019; Accepted: December 13, 2019; Published: December 19, 2019

Citation: Safae M, Myriam L, Karima S, Mariam M (2019) Scalp White Piedra caused by Trichosporon asahii. J Clin Exp Dermatol Res. 10:513. DOI:10.35248/2155-9554.19.10.514

Copyright: © 2019 Safae M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, whichpermits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

J Clin Exp Dermatol Res, Vol.10 Iss.6 No:1000514 1