B36.2 White piedra

Name of the Condition

• White piedra

Summary

White piedra is a superficial fungal infection of the hair shaft caused by Trichosporon species. It results in the formation of soft, white or light-colored nodules on the hair, typically affecting the scalp, beard, or pubic hair. The condition is generally mild and cosmetic, though it may cause hair breakage or discoloration.

Causes

White piedra is caused by fungi of the genus Trichosporon, which are part of the normal environmental flora. Infection occurs when these fungi colonize the hair shaft, often in warm, humid conditions. Transmission can occur through direct contact with contaminated hair, shared personal items, or environmental exposure.

Risk Factors

• Warm, humid climates
• Poor hair hygiene or infrequent washing
• Shared personal items (e.g., combs, brushes)
• Occupational or recreational exposure to contaminated environments
• Pre-existing scalp conditions or hair damage

Symptoms

• Soft, white or light-colored nodules attached to the hair shaft
• Nodules may be easily movable along the hair
• Minimal to no itching or discomfort
• Possible hair breakage or discoloration

Diagnosis

Diagnosis is based on clinical examination of the hair and scalp. Microscopic examination of hair samples may reveal the characteristic fungal elements, including arthroconidia and hyphae. Culturing the fungus can confirm the specific Trichosporon species, though this is not always necessary for mild cases.

Treatment Options

• Shaving or trimming affected hair (for localized cases)
• Topical antifungal agents (e.g., selenium sulfide, ketoconazole)
• Oral antifungal medications for widespread or recurrent infections
• Improved hair hygiene and avoidance of shared items

Prognosis and Follow-Up

Prognosis is excellent with appropriate treatment, as the infection is typically mild and responsive to therapy. Recurrence may occur if exposure to the causative fungus persists. Follow-up is generally not required unless symptoms persist or worsen.

Complications

• Hair breakage or temporary hair loss
• Cosmetic concerns due to visible nodules
• Secondary bacterial infection (rare)

Lifestyle & Prevention

• Maintain good hair hygiene with regular washing
• Avoid sharing personal hair care items
• Keep hair dry and avoid prolonged moisture
• Use antifungal shampoos prophylactically in high-risk environments

When to Seek Professional Help

Seek medical attention if nodules persist despite hygiene measures, if hair loss or discomfort occurs, or if the infection spreads to new areas. Consult a healthcare provider for persistent or recurrent cases.

Tips for Medical Coders

Document the location of the infection (e.g., scalp, beard) and any associated symptoms. Ensure the diagnosis is confirmed by clinical or microscopic findings. Code B36.2 is specific to white piedra and should be used when the condition is identified.