White piedra may have a gelatinous appearance. Hair culture can be used to grow the anaerobic diphtheroids present as short gram-positive rods. These cases document the presence of filamentous bacterial growth perpendicular to the hair shaft, present in a background of elaborated cement substance that makes up the concretions. The bacteria adhere to but do not penetrate the hair shaft. Superinfection with cocci or fungi also can be present.
Treatment involves alleviating the hyperhidrosis through the use of drying agents.
Topical clindamycin is helpful in refractory or extensive cases. The goals of pharmacotherapy are to reduce morbidity and to prevent complications. Has shown fungistatic activity against Candida species. Treatment should continue up to 4 wk. If no improvement is noted, re-evaluate patient.