A Rare Case of Coinfection with White Piedra and Pediculosis Capitis

In 2017, a 30-year-old woman presented with symptoms of itching and "dirt" sticking to her hair. Upon examination, multiple white-to-brownish nodules were found on her hair shaft, along with structures resembling nits. After conducting several tests, including a Wood's lamp examination and direct microscopy of the affected hair, the woman was diagnosed with a rare coinfection of white piedra and pediculosis capitis. White piedra, a superficial fungal infection of the hair shaft caused by Trichosporon, presents as nodules stuck to the hair shaft. The woman's lifestyle, including her habit of tying her hair into a braid before drying and her use of coconut hair oil, likely contributed to the fungal infection. Despite treatment with 1% permethrin rinse and topical ketoconazole shampoo, the piedra showed little improvement after 3 weeks. However, after being prescribed oral itraconazole 100 mg per day, the woman saw significant improvement after 10 weeks of continuous therapy.