Black piedra
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Overview
| Black piedra | |
| ICD-10 | B36.3 |
|---|---|
| ICD-9 | 111.3 |
| DiseasesDB | 31872 |
| eMedicine | derm/788 |
| MeSH | D010854 |
Black piedra is a form of piedra caused by Piedraia hortae.[1]
Terbinafine has been used in the treatment.[2]
Differential Diagnosis
Black piedra should be differentiated from other diseases presenting as red, pruritic, annular, scaly rash. The differentials include the following:
| Name of superficial infection | Clinical presentation | Extension to hair follicle | Fungus(i) | Systemic disease | KOH preparations | Morphology in tissue sections |
|---|---|---|---|---|---|---|
| Tinea or ringworm | Round lesions with scaly border, accompanied by pruritis and burning | Yes; when suppurative known as kerion, when chronic known as Majocchi's granuloma | Dermatophytes (Epidermophyton spp., Trichophyton spp., Microsporum spp.) | Very rare but can invade the dermis and soft tissues, causing mycetomas | Hyphae with or without septations | Hyphae cannot be visualized in the keratin with H&E, special stains are needed |
| Tinea versicolor | Hypo and hyperpigmentation in patients with oily and sweaty skin, fine scales when scratching | Yes, known as Pityrosporum folliculits | Malassezia spp. | Systemic infections may occur in premature neonates receiving parenteral nutrition and in other immunosuppressed hosts | Yeasts and hyphae (“spaghetti and meat balls”) | Faintly basophilic hyphae in the stratum corneum |
| Tinea nigra | Brown to black macule, usually on palms, with some scaling | No | Phaeoannellomyces werneckii | Not described | Darkly pigmented, septated, and branching hyphae | Pigmented hyphae in the stratum corneum |
| White piedra | Creamy-white, small, soft nodules in hair shafts | No | Trichosporon spp. | Immunosuppressed patients may have lung infiltrates, renal involvement, and fungemia | Septate hyphae perpendicular to hair shaft | Not used for diagnosis |
| Black piedra | Hard dark nodules in hair shafts | No | Piedraia hortae | Not described | Collections of crescent ascospores surrounded by pigmented hyphae | Not used for diagnosis |
| Superficial candidiasis | Intertrigo, chronic paronychia, onychodystrophy, cheilitis | Yes | Candida spp. | Yes, particularly in patients with AIDS and depending on the level of immunosuppression | Yeasts, pseudohyphae may be observed | Fungal elements may be seen through the biopsy, vascular invasion must be determined |
See also
Gallery
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![Under a relatively-low magnification of 100X, this photomicrograph reveals some of the pathologic morphology displayed by a primate hair shaft indicative of the disease known as, “black piedra”, also known as “trichosporosis”, which is caused by the fungal organism, Piedraia hortae. From Public Health Image Library (PHIL). [3]](/images/2/2e/Black_piedra01.jpeg)
Under a relatively-low magnification of 100X, this photomicrograph reveals some of the pathologic morphology displayed by a primate hair shaft indicative of the disease known as, “black piedra”, also known as “trichosporosis”, which is caused by the fungal organism, Piedraia hortae. From Public Health Image Library (PHIL). [3] -
![This is a photomicrograph of a hair shaft with a condition called “black piedra” due to Piedraia hortae. From Public Health Image Library (PHIL). [3]](/images/4/47/Black_piedra03.jpeg)
This is a photomicrograph of a hair shaft with a condition called “black piedra” due to Piedraia hortae. From Public Health Image Library (PHIL). [3] -
![This is a photomicrograph of the mycelium of the fungus Piedraia hortae, magnified 475X. From Public Health Image Library (PHIL). [3]](/images/4/43/Black_piedra04.jpeg)
This is a photomicrograph of the mycelium of the fungus Piedraia hortae, magnified 475X. From Public Health Image Library (PHIL). [3] -
![This is a plate culture of Piedraia hortae, strain A272. From Public Health Image Library (PHIL). [3]](/images/9/9a/Black_piedra05.jpeg)
This is a plate culture of Piedraia hortae, strain A272. From Public Health Image Library (PHIL). [3]
![Under a relatively-low magnification of 100X, this photomicrograph reveals some of the pathologic morphology displayed by a primate hair shaft indicative of the disease known as, “black piedra”, also known as “trichosporosis”, which is caused by the fungal organism, Piedraia hortae. From Public Health Image Library (PHIL). [3]](/index.php/File:Black_piedra01.jpeg)
![This is a photomicrograph of a hair shaft with a condition called “black piedra” due to Piedraia hortae. From Public Health Image Library (PHIL). [3]](/index.php/File:Black_piedra03.jpeg)
![This is a photomicrograph of the mycelium of the fungus Piedraia hortae, magnified 475X. From Public Health Image Library (PHIL). [3]](/index.php/File:Black_piedra04.jpeg)
![This is a plate culture of Piedraia hortae, strain A272. From Public Health Image Library (PHIL). [3]](/index.php/File:Black_piedra05.jpeg)
References
- ↑ "eMedicine - Piedra : Article by Robert A Schwartz". Retrieved 2008-11-08.
- ↑ Gip L (1994). "Black piedra: the first case treated with terbinafine (Lamisil)". The British journal of dermatology. 130 Suppl 43: 26–8. PMID 8186138. Unknown parameter
|month=ignored (help) - ↑ 3.0 3.1 3.2 3.3 "Public Health Image Library (PHIL)".