Dermatology: Practical and Conceptual Image Letter | Dermatol Pract Concept. 2023;13(3):e2023165 1 Black Piedra in an Amerindian Girl with Oculocutaneous Albinism Type 2 Jaime Piquero-Casals1, Daniel Sesto-Casals2, Jose Sandro Savino-Asprino3, Eduardo Rozas-Muñoz4, Juan Francisco Mir-Bonafé5, Daniel Morgado-Carrasco6 1 Department of Dermatology, Dermik Multidisciplinar Dermatology Clinic. Barcelona, Spain 2 Department of Dermatology, Hospital General Santa Maria del Puerto, Cadiz, Spain 3 Department of Ophthalmology, Hospital Mateu Orfila, Menorca, Spain 4 Department of Dermatology, Hospital San Pablo, Coquimbo, Chile 5 Department of Dermatology, Hospital Son Llàtzer, Palma de Mallorca, Spain 6 Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Spain Citation: Piquero-Casals J, Sesto-Casals D, Savino-Asprino JS, Rozas-Muñoz E, Mir-Bonafé JF, Morgado-Carrasco D. Black Piedra in an Amerindian Girl with Oculocutaneous Albinism Type 2. Dermatol Pract Concept. 2023;13(3):e2023165. DOI: https://doi.org/10.5826/ dpc.1303a165 Accepted: January 15, 2023; Published: July 2023 Copyright: ©2023 Piquero-Casals et al. This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing interests: None. Authorship: All authors have contributed significantly to this publication. Corresponding author: Jaime Piquero-Casals, MD PhD, Department of Dermatology Dermik Multidisciplinar Dermatology Clinic. Barcelona, Spain. Phone: (+34) 932279867, FAX: (+34) 932275438 E-Mail: j.piquero@dermik.es Case Presentation A 9-year-old Piaroa girl with oculocutaneous albinism type 2 hailing from Venezuelan Amazonian, presented with mul- tiple 1 to 2-millimeter blackish small nodules attached to her scalp hair (Figure 1A). Microscopic examination of the hair shafts revealed brown to black firmly concretions (Figure 1B). Culture on Sabouraud agar at 25 °C showed after two weeks, slow growth of compact, domed black col- onies. Microscopic examination of culture isolated shows asci and ascospores of piedraia hortae confirmed the black piedra diagnosis. Oral and topical antifungal are frequently unsuccessful and shaving or clipping the hair is the most accepted alterna- tive, but this may not be considered cosmetically or socially acceptable. When we suggest to our patient the possibility of cutting her hair to cure the disease; the patient showed us how when rubbing the hair with the sand from the river the nodules were detached easily. In the city, cleanser scrubs can be used as an alternative. Teaching Point Black piedra, caused by the dematiaceous filamentous fungus Piedraia hortae, is usually seen in the tropics worldwide. Con- sists of black-colored, firm, irregular nodules, located in the hair cuticle. Sources of infection are soil- and environment- related in tropical rainforest [1]. Differential diagnosis in- cludes pediculosis capitis, white piedra and trichorrhexis nodosa. Dermoscopy should be included as a part of the clin- ical inspection to avoid unnecessary invasive investigation or diagnostic delay [2]. 2 Image Letter | Dermatol Pract Concept. 2023;13(3):e2023165 References 1. Veasey JV, Avila RB, Miguel BAF, Muramatu LH. White pie- dra, black piedra, tinea versicolor, and tinea nigra: contribu- tion to the diagnosis of superficial mycosis. An Bras Dermatol. 2017;92(3):413-416. DOI: 10.1590/abd1806-4841.20176018. PMID: 29186263. PMCID: PMC5514591. 2. Piccolo V. Update on Dermoscopy and Infectious Skin Diseases. Dermatol Pract Concept. 2019;10(1):e2020003. DOI: 10.5826/ dpc.1001a03. PMID: 31921490. PMCID: PMC6936624. Figure 1. (A) Multiple 1 to 2-mm blackish nodules attached to the hair shaft in a OCA-2 patient. (B) 10X microscopic examination of the hair shafts revealed brown to black firmly concretions.