980                       DISEASES OF THE APPENDAGES

PIEDRA¹

Synonyms.—Fr., Trichomycose nodulaire (Juhel-Rénoy); Trichosporosis nodosa
(Macleod).

This is a condition of the hair, studied by Osorio, Malcolm Morris,
Desenne, Juhel-Rénoy, Lion, Behrend, Unna, and others, characterized
by minute, pin-head-sized, hard nodules on the hair-shaft—in appearance
somewhat suggestive of nits, but much smaller. It is rarely seen outside
of Cauca, of the United States of Colombia, South America, although a
few instances (Unna, Behrend) have been observed in Europe. It is
not improbable that the “chignon disease” (chignon fungus), essentially
similar in its symptomatology, described by Beigel² and T. Fox,³ which
apparently was at one time not infrequent in Europe, is, as Behrend sug­
gests, identical with piedra. The affection is, with some exceptions,
limited to the scalp hairs of the native women; occasionally, however, it
is also noted in men, and either on the scalp or bearded parts. Hyde
and Montgomery⁴ briefly refer to a case of a young girl in whom the
nodules were seated on the eyelashes of both eyes. The nodules are
dark-colored, gritty, and almost stony hard, and, if numerous, give out,
when the hair is combed or shaken, a crepitant or rattling noise. One
to ten or more, irregularly placed, maybe attached to a single hair-shaft,
but, as a rule, the nearest to the scalp is not less than \ inch dis­
tant. The view held by Desenne and Morris that the concretions are
due to fungus growths has been confirmed by Juhel-Rénoy, Behrend,
.Unna, and others, although some slight differences have been observed.
Unna and Trachsler believe that the formations may be due to several
forms of fungus, the spores being of various size. The women of Cauca
are in the habit of using a mucilaginous oil for a hair-dressing, and
Morris considers that this is probably an important factor. The con­
cretions may be either on the side of a hair or may completely encompass
it. The structure of the hair does not suffer, as in trichorrhexis nodosa
and monilethrix, and this serves well as a differential factor in the diag­
nosis. Lepothrix occurs only on the axillary and scrotal hairs, nor is
it due to a mycelium-forming fungus.

The treatment suggested by Juhel-Rénoy and Lion, based upon
their culture experiments, consists in frequent washings with hot corrosive
sublimate solution, 1: 1000, the hot water softening the nodules and per­
mitting thorough penetration. The same plans used for softening and
detaching nits can also be employed.

¹ Literature: Malcolm Morris, London Pathol. Soc’y’s Trans., 1879, vol. xxx, P.
441; Med. Times and Gaz., 1879, i, P. 409 (with discussion); Desenne, Compt. rend,
de l' Acad. des Sci., 1878, vol. lxxxvii, p. 34—editorial abs. in Lancet, 1878, vol. ii,
p. 165; Juhel-Rénoy, Annales, 1888, p. 777 (illustrations of hair and fungus); Juhel-
Rénoy and Lion, ibid., 1890, p. 765 (with culture-tube illustrations); G. Behrend,
Berlin, klin. Wochenschr., May 26, 1890, p. 464; Unna, Lewin`s Festschrift, Berlin,
1896; abs. in Brit. Jour. Derm., 1876, p. 111; Trachsler, Monatshefte, 1896, vol. xxii,
p. 1 (with illustrations of hair and cultures); Pernet, Brit. Jour. Derm., 1900, p. 141
(fungus demonstration); Macleod, ibid., 1912, p. 132 (review, hair and fungus illustra­
tions, cultures, and references); Dubois, “Etude d‘ un Case de Trichosporie, Annales,
1910, p. 447 (with review and illustrations).

² Beigel, The Human Hair, p. 111.

³ T. Fox, Jour. Cutan. Med., 1868, vol. i, p. 175 (with illustrations).

⁴ Hyde and Montgomery, Diseases of the Skin.

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