Hi XXXXXXX,

Welcome to XXXXXXX

You have mentioned three chief complaints ( itching, scaling or flakiness and foul smelling discharge) which points towards few possibilities-
1) fungal infection with secondary bacterial infection or intertrigo
2) seborrheic dermatitis or some other eczematous condition
3) psoriasis

As far as white piedra is concerned, it is a type of fungal infection where white or gray beads strongly adhere to hair shaft and cannot be easily removed. More or less it is asymptomatic. So basically a chance of you having it is very unlikely.
The whitish or blackish dry substance is basically your shedding dry skin and a foul discharge can be present in any of the above mentioned possibilities.

To treat your condition, as a general precautionary measure, follow these-
1) Shave your pubic hair regularly.
2) Wear loose cotton underclothes and change twice if you perspire a lot, in summers, during humid conditions.
3) Dab the area with anti fungal powder.
4) After bathing, dry the area completely and then only wear your clothes.

For appropriate treatment, a definite diagnosis is required for which a visit to dermatologist is requested.

Use of anti fungal cream like clotrimazole or terbinafine in combination with an antibiotic cream (fusidic acid) and a steroid like mometasone might be required. Depending on the severity of condition, oral antifungal or oral antibiotic might also be advised. Itch guard is an over the counter cream and can provide partial relief in any of the differentials I have given above. I would request you to stop using the same for a while. Also take oral anti-histamine like cetirizine to relieve itching.

Hope that answers your query. Should you be requiring an advice further, please feel free to send your query. I would be happy to help you out.

Take care.

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Hi XXXXXXX,

Thanks for writing in.

White piedra presents itself as whitish or greyish gelatinous nodules attached to the hair shaft (these may appear like lice attached to hair). It is basically infection of the hair shaft not involving underlying skin.

When I mentioned asymptomatic, I meant that basically the disease doesn't lead to any symptoms such as itching, scaling of skin or foul smelling discharge. The only noticeable change in piedra would be breakage of public hair and attached nodules.

In your case, the whitish or yellowish beads on pubic hair could be due to matting of hair with the slight serous discharge associated with the other conditions I mentioned earlier.

Regular use of antifungal cream, shampoo and FCN would help in treating fungal infection and to some extent seborrheic dermatitis too and hence the improvement in symptoms.

As far as treating piedra is concerned shaving the pubic hair, use of terbinafine or clotrimazole cream along with oral itraconazole would provide complete cure. The same would also be effective in any fungal infection.

Hope that answers your query. Happy healing!

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Hi XXXXXXX,

You can try using both terbinafine +mometasone cream (anti fungal and steroid) and fusidic acid cream (antibacterial). I would advise both, because it would not only treat fungal infection but would also take care of bacterial infection if there is any (I am suspecting it as you have foul smelling discharge too). Also take tab cetirizine to alleviate itching.

As far as taking fluconazole is concerned, it can be taken if disease is severe or refractory to topical treatment.

To prevent recurrence, kindly follow the general precautionary measures I have mentioned in our first discussion..
I would also like to mention these are prescription drugs and dermatology being a visual field, it is always a good decision to visit a dermatologist when possible to arrive at a definite diagnosis.

Hope I have answered your queries to satisfaction. Take care.

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