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Piedra, also known as trichomycosis nodularis is a common asymptomatic fungal infection of hair shaft. Two types of piedra have been described namely black piedra and white piedra. Both types of hair fungus ultimately may lead to hair breaking because the shaft is weakened by cuticular penetration.

Black Piedra

Black piedra is caused by Piedraia hortae and is characterized by the presence of firmly attached, black/brown, hard nodules on the hair shaft. It is commonly seen in scalp hair, less frequently observed in the beard, moustache and pubic hair. Nodules may be seen on the frontal scalp and vary in size ranging from 1mm or more in diameter. As fungus grown in the hair shaft, the hair may break easily. If untreated the infection may last for years.

White Piedra

White piedra is caused by species of Trichosporon genus and is characterized by the presence of loosely attached whitish/ light-brown or cream colored soft nodules on the infected hair shaft. Their size may vary from microscopic to 1 mm in diameter. White piedra usually affects facial (beard, mustaches, eyelashes and eyebrows) underarms and genital hairs and less commonly scalp. As white piedra affects outer lipid layer, the soft white nodules can be easily detached from hair shaft. Broken hair is less commonly seen than black piedra.

How is it diagnosed?

Most diagnosis is based on direct clinical as most cases are characteristics. If there is confusion fungal testing can be done to exclude other disease like trichomycosis axillaris.

Treatment of Piedra

Shaving the infected hair is the best and simplest treatment and is curative therapy for both cases of white piedra and black piedra. Topical uses of anti-fungal medications like 2% ketoconazole, 1% terbinafine, 2% miconazole for at-least 2-3 weeks may also aid in the cure and prevent relapse. To achieve more successful results, Alternate days shampooing with antifulgal shampoos in combination with above topical cream and lotions may be needed. In severe and unresponsive oral antifungal medications like itraconazole may be given along with topical medications.


  1. Lee Ann Trueblood
    February 5, 2020 at 12:35 am

    . I need to visit a third world country for diagnosis and treatment. The 19 doctos I have seen refuse to see my issues. Black clumps in hair, urine throoad. lungs.I have untreated and undiagnosed Black Piedra Fungus. Sick since June, 2018.
    Please advise

  2. Meg
    November 6, 2020 at 11:48 pm

    This is something I have also had for two years. Every doctor I have seen, and I’ve seen many, say there is nothing wrong. A few asked if I was on drugs?! I have light brown hair, black roots are not normal! This is something that seems to be uncommon in the US but more and more it’s occuring. Because I see my same scenario on sites like this everywhere.

  3. Kd
    December 30, 2020 at 7:20 pm

    5yr suffering so frepressing Doc ssid nothi g wrong with feel black thinh fallinh out your hair pain un heeathy life try all remedies shampo that reasrarchi how find out was piedrs all dytom know my Doc ,going help mre

  4. Dana
    April 21, 2021 at 10:46 am

    I be been doing this bull crap for 2 and a half years now as well.
    BACTRIM is a goog antibiotic to make it all go away …and it did but some how I’ve acquired it again…so back to the dermatologist…lol

  5. KirQ
    November 29, 2021 at 10:46 am

    RIDICULOUS how much the doctors in the U.S. DON’T know about black or white piedra. I have been suffering with a case of mixed black and white piedra since August of 2020, well over a year. Derm #1 said it was ringworm. Gave me rx for ketoconazole shampoo. It got worse. I went to another derm #2. She said nothing wrong. Second visit – I had nits….wrong, WELL combing through fungus in hair makes it spread all over. I finally took close up pictures and diagnosed it myself. Go back to young Derm #2 and she tells me to go seek a psychiatrist and get mental help. All along, I have piedra. She does not see, nor test for it, but is RATHER quick to judge me rather than being wrong or being a good doctor. So I wind up having to shave my entire head to try to save my hair that is being untreated. Same situation with Derm #3, Derm #4, Derm #5, and finally Derm #6 at a major hospital, who tested only my skin (not the hair) and comes up with general Granuloma and tells me to see my regular physician .WOW.
    So the I got the Rx I need from a different source – bc now it has spread from my scalp to my entire body. They know NOTHING about this here. Next step is to find Derm #7 and make sure they have experience in treating tropical diseases, namely piedra. I might have to call a doctor in NY or FL, who seem to have experience with black and white piedra, and them have them recommend someone in the CHicago area who also does. I live in a major metropolitan area and cannot locate a doctor with any experience in dealing with piedra. It freaks them OUT. They don;t know what to do and tell me to go find another doctor. It’s so disheartening and I feel hopeless. Anyone out there find a doctor who can treat black and white piedra in the U.S.??? Please share their name. I suspect there’s quite a few of us looking for someone who can treat this.

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