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White piedra and pediculosis capitis in the same patient

Authors:
Silvio Alencar Marques at São Paulo State University
Silvio Alencar Marques
Virgínia Bodelão Richini-Pereira at Instituto Adolfo Lutz
Virgínia Bodelão Richini-Pereira
Rosangela Maria Pires de Camargo at São Paulo State University
Rosangela Maria Pires de Camargo
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Abstract and Figures

White piedra is a superficial mycosis caused by the genus Trichosporon. It is characterized by nodules on the hair shaft. Pediculosis capitis is caused by Pediculus humanus var. capitis of the suborder Anoplura. Whereas pediculosis is a common infestation, clinical reports of white piedra are rare. Molecular biology procedures identified T. inkin as the agent of white piedra in this case report. The authors present associations between the two diseases in the same patient in order to highlight their clinical differences.
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White piedra and pediculosis capitis in the same patient
*
Piedra branca e pediculose capitis no mesmo paciente
Silvio Alencar Marques
1
Virgínia Bodelão Richini-Pereira
2
Rosângela Maria Pires de Camargo
3
Abstract: White piedra is a superficial mycosis caused by the genus Trichosporon. It is characterized by
nodules on the hair shaft. Pediculosis capitis is caused by Pediculus humanus var. capitis of the suborder
Anoplura. Whereas pediculosis is a common infestation, clinical reports of white piedra are rare.
Molecular biology procedures identified T. inkin as the agent of white piedra in this case report. The
authors present associations between the two diseases in the same patient in order to highlight their cli-
nical differences.
Keywords: Lice infestations; Piedra; Trichosporon
Resumo: Piedra branca é micose superficial causada pelo gênero Trichosporon e caracterizada por
nódulos aderidos à haste do pelo. Pediculose capitis é causada pelo Pediculus humanus var. capitis per-
tencente à subordem Anoplura. Enquanto que a pediculose é enfermidade comum, relatos clínicos de
piedra branca são raros. Técnicas de biologia molecular identificaram o agente de piedra branca do pre-
sente relato como T.inkin. Os autores apresentam associação de ambas as infestações no mesmo pacien-
te para salientar seus aspectos clínicos distintos.
Palavras-chave: Infestações por piolhos; Piedra; Trichosporon
Received on 10.03.2012.
Approved by the Advisory Board and accepted for publication on 23.04.2012.
* Work conducted at the Department of Dermatology and Radiotherapy, Faculdade de Medicina de Botucatu (School of Medicine of Botucatu), Universidade
Estadual Paulista “Julio de Mesquita Filho” (Julio de Mesquita Filho Sao Paulo State University – (FMB-UNESP) - Botucatu (SP), Brazil.
Conflict of interest: None
Financial funding: None
1
Full professor – Professor, Department of Dermatology and Radiotherapy, Faculdade de Medicina de Botucatu (School of Medicine of Botucatu), Universidade
Estadual Paulista “Julio de Mesquita Filho” (Julio de Mesquita Filho Sao Paulo State University – (FMB-UNESP) - Botucatu (SP), Brazil.
2
Post-doctoral student – Department of Veterinary Hygiene and Public Health, Universidade Estadual Paulista “Júlio de Mesquita Filho” (UNESP) – Botucatu (SP),
Brazil.
3
Biologist – Laboratory of Medical Mycology, Department of Dermatology and Radiotherapy, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista
“Julio de Mesquita Filho” – (FMB-UNESP) - Botucatu (SP), Brazil.
©2012 by Anais Brasileiros de Dermatologia
▲
White piedra is characterized by whitish nodu-
les firmly attached to the hair shaft. It occurs in tropi-
cal and subtropical regions, and humidity associated
with poor personal hygiene is a predisposing factor.
1-3
Pediculosis capitis is a worldwide infestation, and it is
related to close personal contact or comb and hair-
brush sharing. The association of both diseases in the
same patient is uncommon, and it may be overlooked
due to inattentive or careless examination. We report
the case of a 21-year-old woman who complained of
whitish spots on scalp hair shafts and of mild local
pruritus. On examination, whitish nodules firmly atta-
ched to hair shafts and similar, not firmly attached
nodules were observed on the same or on isolated
hair shafts (Figure 1). Dermoscopy and direct exami-
nation identified distinct infectious agents (Figures 2
and 3). Trichosporon spp. was cultured on Sabouraud-
An Bras Dermatol. 2012;87(5):786-7.
786
IMAGING IN TROPICAL DERMATOLOGY
FIGURE 1: Nodules of white piedra on the upper part of the hair
and lice of pediculosis on the lower part of the hair
An Bras Dermatol. 2012;87(5):786-7.
White piedra and pediculosis capitis in the same patient 787
How to cite this arti cle: Marques AS, Richini-Pereira VB, Camargo RMP. White piedra and pediculosis capitis in
the same patient. An Bras Dermatol. 2012;87(5):786-7.
REFERENCES
Chagas-Neto TC, Chaves GM, Colombo AL. Update on the Genus Trichosporon.1.
Mycopathologia. 2008;166:121-32.
Diniz LM, Souza Filho JB. Estudo de 15 casos de piedra branca observados na2.
Grande Vitória (Espírito Santo-Brasil) durante cinco anos. An Bras Dermatol.
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Roselino AM, Seixas AB, Thomazini JA, Maffei CML. An outbreak of scalp white3.
piedra in a Brazilian day care. Rev Inst Med Trop São Paulo. 2008;50:307-9.
Sugita T, Nakajima M, Ikeda R, Mattsushima T, shinoda T. Sequences analysis of4.
the ribossomal DNA intergenic spaces 1 region of Trichosporon species. J Clin
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MAILING ADDRESS / ENDEREÇO PARA COR RES PON DÊN CIA:
Silvio Alencar Marques
Depto. de Dermatologia e Radioterapia
Faculdade de Medicina - UNESP-Botucatu
Distrito de Rubião Júnior, s/n –
18618-970 Botucatu, SP
E-mail address: smarques@fmb.unesp.br
dextrose agar. Then, it was identified by molecular
methods using ITS4 and ITS5 primers, compared with
information on the NCBI database and finally confir-
med as Trichosporon inkin (access: HM046988.1
GI:295824566) (Figure 4).
4,5
White Piedra was treated
with ketoconazole shampoo, and pediculosis was
treated with ivermectin, with successful results, which
remained over a one-year follow-up period. q
FIGURE 2: Direct microscopic examination of a nodule of white
piedra with arthroconidia attached to the hair
FIGURE 4: Yeast culture with a cerebriform aspect and microculture
showing the presence of arthroconidia of different shapes and
blastoconidia; diagnoses of Trichosporon spp
FIGURE 3: Direct
microscopic
examination
showing viable
louse attached
to the hair
... The coexistence of fungal infection with scalp pediculosis in the same patient is restricted to 2 case reports of white piedra occurring with pediculosis capitis [4,5]. To our knowledge, this is the first reported coinfection of pediculosis capitis and tinea capitis in the same patient. ...
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... With the advent of dermoscopy, the diagnosis of WP has become easier because the whitish nodules that distinguish it from other fungal conditions such as black piedra, caused by the black fungus Piedraia hortae, can be clearly observed. It should also be distinguished from pediculosis nits, which may even coexist with WP, and some other hair diseases such as trichomycosis, trichorrhexis nodosa, and pili torti [3,4,[16][17][18][19]. ...
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