What is Black Piedra (Trichomycosis Nodosa)?
Black piedra is a type of fungal infection that affects the hair shafts, also referred to as Trichomycosis nodosa. The fungus attaches itself to the hair forming clusters or nodules along the hair strand. It often affects hair on the scalp, but it can also involve facial hair like the beard and mustache, and even pubic hairs. This condition is commonly found in hot and humid regions, such as South America and Southeast Asia, but is relatively rare in Europe. It can affect both humans and other primate species.
What Causes Black Piedra (Trichomycosis Nodosa)?
Black piedra is caused by a specific fungus named Piedraia hortae. This fungal infection often occurs due to poor cleanliness. It’s commonly seen in individuals who have long hair and frequently use various types of hair oil. Additionally, habits like wearing veils or tight hats for a long time can make the condition worse. Some reports also suggest that it can be sexually transmitted.
The number of people getting fungal infections is increasing. This is mainly because the fungi that cause these infections take advantage of weak immune systems, and there are many conditions that can reduce the strength of your immune system. So more people are now at risk of getting these infections.
Risk Factors and Frequency for Black Piedra (Trichomycosis Nodosa)
Black piedra is an infection usually found in tropical and subtropical areas. Despite being prevalent in these regions, it can still occur in other parts of the world, including Europe, mainly due to international travel. How piedra spreads is still a mystery, although it could potentially pass from person to person through shared objects like combs or bed linens. Piedra can develop at any age, but its frequency generally decreases after middle age. It’s extraordinarily unusual to have both types of piedra – black and white – at the same time.
- Black piedra is typically seen in tropical and subtropical regions.
- The infection can also occur in other areas like Europe due to global travel.
- The exact method of piedra transmission is not well understood.
- Possible means of transmission could include sharing objects like combs or bedsheets.
- Piedra can affect people of all ages but is less common after middle age.
- It’s very rare for a person to have both black and white piedra at the same time.
Signs and Symptoms of Black Piedra (Trichomycosis Nodosa)
Black piedra is a condition that does not cause any symptoms other than some noticeable changes to the hair. People with this condition will have brown to blackish nodules stuck firmly to their hair strands. These nodules are gritty when felt and are less than 1mm big. They often differ in size and shape, from microscopic to 1mm or more in diameter, and can be oval or elongated. These tiny lumps are made up of a compact substance that envelops the hair strand. The hair may become weak at the point where these growths attach and may even break off. This condition is long-lasting and can persist for months or even years without causing any other symptoms.
Testing for Black Piedra (Trichomycosis Nodosa)
If you’re dealing with hair-related concerns, your doctor might use a technique called trichoscopy. This involves examining your hair through a special magnifying device to help determine the cause of your problem. For example, the doctor can tell the difference between real lice eggs (nits) and false lice eggs (pseudonits). This process allows the doctor to see brown-black spots on your hair that are shaped like ovals or elongated shapes.
If there’s a need to understand your condition further, your doctor might perform a Direct Microscopic Examination (DME). This process involves taking a small sample and crushing it before mixing it with a solution called 10% KOH. This mixture will then be viewed under a microscope. The results might show branched fibrous structures, or hyphae, that are grouped together by a substance that resembles cement. These hyphae look like chains of sturdy cells with hard walls that almost resemble cells splitting apart, known as arthrospores. Special dyes, like lactophenol cotton blue, can be used to see these structures better.
Your doctor might also decide to do a fungal culture – another type of lab test that can be very useful. The sample is placed on a substance called Sabouraud dextrose agar (SDA) and left at room temperature to see if any fungus grows. If it does, you might see a smooth greenish-black spot with a raised and cerebriform (brain-like) center. The back of this spot is black. Worth noting, this test works even when it includes cycloheximide, a substance that usually stops fungus from growing.
The microscopic examination of these spots might show round, dark brown structures known as asci that contain spores (which are like seeds for the fungus).
Treatment Options for Black Piedra (Trichomycosis Nodosa)
One way to completely eliminate a specific type of fungal infection, or if it’s infecting the head, is to shave all the hair off. However, this might not be a preferable option for many women due to cosmetic concerns.
There are antifungal creams or shampoos that are very effective in treating this type of infection. These are typically used once a week for a duration of three weeks. These contain active ingredients like ketoconazole or miconazole which are effective in fighting the fungus. Similarly, some types of lotions can be left on the scalp to battle the infection. These lotions typically contain ciclopirox.
Previously, treatments would consist of an ointment containing benzoic acid compound or a solution of mercury perchloride applied after shampooing. These treatments functioned as antifungal applications.
If the fungus proves to be resistant to creams or shampoos, oral antifungal medicines, like terbinafine and itraconazole, have been used successfully. A commonly used treatment is a daily 250 mg dose of terbinafine for six weeks.
In some cases when the fungus does not respond to the antifungal shampoos alone, a substance called salicylic acid may be added. This substance helps to remove the layer of skin on the scalp affected by the fungus, aiding the shampoo in treating the infection.
What else can Black Piedra (Trichomycosis Nodosa) be?
Black piedra, a fungal infection that causes black nodules on the hair, is often mistaken for a condition called pediculosis capitis, or a head lice infestation. This is because lice eggs, also known as nits, can resemble black piedra nodules. These nits can be white, light gray, tan, or yellowish, and they attach tightly to the hair shafts, making them hard to remove. Nits with viable eggs are typically found near the scalp. Making a definite diagnosis involves confirming the presence of viable eggs, nits in various stages, or adult lice.
Another condition, white piedra, also affects the hair but is caused by a different fungus, Trichosporon spp. Unlike black piedra, white piedra doesn’t just affect the scalp hair, but can also appear on other hair-bearing areas of the body. It appears as a whitish material that loosely adheres to the hair shafts. Microscopy tests and fungal cultures can easily differentiate between white and black piedra.
A hair shaft disorder known as Trichorexis nodosa is characterized by fragile hair that tends to break easily. It can be identified microscopically by nodules along the hair shaft, where hair fractures and the individual cells of the hair shaft separate from the main body.
Lastly, Monilethrix is a rare hereditary hair disease that results in short, brittle hair that looks beaded. Under light microscopy, the hair shaft of affected individuals shows elliptical or spindle-shaped swellings, which are separated by narrower areas known as internodes.
What to expect with Black Piedra (Trichomycosis Nodosa)
The fact that this fungal infection doesn’t spread much outside of its usual area, coupled with the fact that it’s not very harmful, shows that it has a good chance of getting better. With the correct treatment, black piedra (a type of fungus that affects the hair) has a positive outlook. Individuals can expect to recover completely and have their normal hair restored.
Possible Complications When Diagnosed with Black Piedra (Trichomycosis Nodosa)
Black piedra infection generally doesn’t have any severe complications. Nonetheless, if left untreated, individuals who have some other health issues like diabetes, immune system disorders, and cancer could experience hair loss.
There have been instances where individuals with poor scalp cleanliness have had mixed piedra, which is a combination of black and white piedra. There are also reports of people getting head lice as an additional condition.
- No severe complications from Black piedra infection
- Potential hair loss in untreated patients with other health conditions
- Possible cases of mixed piedra in individuals with poor scalp hygiene
- Occasional reports of head lice as a secondary issue
Preventing Black Piedra (Trichomycosis Nodosa)
Black piedra is a condition that doesn’t cause any physical discomfort, but it does create noticeable spots or ‘nodes’ on the hair, which can be unattractive. If not treated, these spots can stick around for many months or even years. This condition can be passed from person to person, so it’s important for those affected and the people closely involved with them to practice good hygiene. This means keeping clean, especially if travelling to hot, humid countries where the infection is more common.
Preventing black piedra is largely centered around personal hygiene. Thus, advice would typically revolve around avoiding sharing items that touch the hair, such as combs or hats and also hair accessories. Additionally, activities such as swimming in stagnant water, which is water that isn’t flowing, should also be avoided as it could potentially be a source of the infection.
