White piedra (WP) is a superficial mycosis caused by yeast fungi of the genera Trichosporon, is a rare infection and asymptomatic, affects the hair at the level of the stem in the form of concretions or adherent nodules, soft whitish, especially those of the head and, in smaller proportion, those of the beard, mustache, eyelashes, armpits and pubis. The main etiological agents are: Trichosporon inkin, Trichosporon ovoides, Trichosporon cutaneum
Our objective is to present our clinical-mycological and therapeutic experience of twelve cases
A retrospective study of WP, seen in the Dermatology Service from 2005 to 2017 (twelve years), was carried out. All cases underwent a clinical history and the diagnosis was checked by the following tests: with Wood's light. Hair was taken for direct tests with KOH (10%); KOH + cotton blue and some parasitized hairs were performed scanning electron microscopy (Jeol® microscope, model JSM-5300); cultures in Sabouraud dextrose agar media with and without antibiotics. The cultures were confirmed by micromorphology and confirmed by two methods: assimilation of carbohydrates by commercial system VITEK® 2YST ID-card and by protein identification with MALDI-TOF MS system (Vitek-MS®). The treatment was based on ketoconazole (2%) in shampoo for 1-2 months and the cases of failure were used Hoffman's liquor (alcohol / ether) + 1% salicylic acid, or one of them plus oral itraconazole.
The principal demographic data: Youngest: 8 year-old; oldest: 31 years-old. Average: 17.25. Children (<15 years old): 7 (58.3%). Adults: 36 (49.31%). Gender:  female: 11 (91.6%); male: 1 (8.4%). Occupation: scholars & students: 8 (66.6%); housewives 3 (25.0%); employed 1 (8.4%). Hairs location: head hairs: 11 (91.6%) and scrotal hairs 1 (8.4%). The predisposing factors: Long hair: 11 cases; Curly hair: 7 cases; Excess of humidity: 9 cases; Diabetes mellitus type-2: 1 case.
Mycological data: Multiple white nodules (concretions) 12 (100%). KOH: microscopic nodules or concretions formed by multiple arthroconidia and hyphae 12 (100%). Etiological agents: Trichosporon inkin 10 (83.3%); Trichosporon cutaneum 1 (8.3%); Trichosporon ovoides 1 (8.3%).
Treatment response: Ketoconazole shampoo (2%): 09/12 cases (75.0%); Itraconazole (200 mg/day) + ketoconazole shampoo (2%) 1/12 (8.4%) and Hoffman liqueur plus salicylic acid 2/12 (16.6%).
The WP, is a rare fungal infection, which affects more the head hairs, our main etiological agent was Trichosporon inkin (83%). The majority of cases were in school-age girls. All the cases presented hairs concretions with conidia. In 75% of cases clinical and mycological cure was achieved with ketoconazole shampoo.


White Piedra. Experience with 12 cases