Nodules on the Hair: A Rare Case of Mixed Piedra

    January 2013 in “ International journal of trichology ”
    Swapna S Khatu, Shital Poojary, Niranjan G Nagpur
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    TLDR A woman's scalp nodules were successfully treated with antifungal and anti-lice medications, revealing a rare case of mixed piedra infection.
    In 2013, a 40-year-old woman from West Bengal experienced difficulty combing her hair due to blackish nodules on her scalp, a condition she had previously encountered and which had resolved with antifungal treatment. Upon examination, she was found to have brown to black nodules on her hair shaft, as well as nits from head lice. Initially diagnosed with black piedra, further analysis using 10% potassium hydroxide and fungal culture identified the presence of two fungi, Piedraia hortae and Trichosporon species, leading to a rare diagnosis of mixed piedra. Treatment with 2% ketoconazole lotion and 1% permethrin was successful in eliminating the nodules. This case represents only the third instance of mixed piedra reported in medical literature, highlighting the necessity of thorough mycological examination and culture to avoid misdiagnosis, as similar symptoms can be caused by white piedra.
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