Long-term pubic dermatitis diagnosed as white piedra

Area of Science:

• Dermatology
• Mycology
• Medical Case Reports

Background:

• Pruritic rashes in the pubic area can be challenging to diagnose, often leading to prolonged patient suffering and multiple unsuccessful treatments.
• A 58-year-old man presented with a 30-year history of an undiagnosed pruritic rash, having seen numerous physicians without a definitive diagnosis.

Observation:

• Physical examination revealed hair shaft concretions in the pubic area.
• Wood lamp examination was crucial in identifying these abnormalities.
• Histologic evaluation confirmed the presence of white piedra (WP).

Findings:

• White piedra (WP) was identified as the cause of the patient's chronic, undiagnosed pruritic rash.
• The patient achieved complete resolution of the eruption following treatment with topical ketoconazole.

Implications:

• This case underscores the importance of considering less common diagnoses like white piedra (WP) in cases of persistent, unexplained dermatitis.
• Wood lamp examination and dermoscopy are valuable, underutilized tools for diagnosing parasitic and fungal infections of hair shafts.
• Increased awareness among healthcare providers can lead to earlier diagnosis and effective treatment of white piedra (WP).