What are the tiny white balls in my hair?

Overview

White piedra is a relatively rare fungal infection of the hair shaft. It is caused by a yeast-like fungus called Trichosporon. The two types of fungus that cause white piedra are T. inkin and T. ovoides. White piedra is generally not contagious.

The primary symptoms of white piedra are white-to-tan gelatinous, pearly nodules surrounding the hair shaft. These nodules are typically found in facial hair and body hair (for example, in mustaches and beards, on eyelashes and eyebrows, and in armpit and pubic hair). The nodules are about 1mm or greater in diameter and are fairly easy to remove.

Other symptoms of white piedra include:

• Brittle, broken hair
• Hair that feels gritty
• Pain or itching

White piedra can occur in any age group and in both sexes, but young men seem to be most at risk. The condition is most prevalent in humid-to-temperate climates. In the United States, most incidences occur in the South, although some cases have also been documented in the Northeast.

White piedra can be confused with other conditions that affect the hair. Here’s how white piedra differs from other hair or scalp conditions:

Lice vs. white piedra

Lice are small, non-flying insects that attach to the hair shaft and suck blood from the scalp. Lice eggs (called nits) are dark colored, but hatched lice are light in color. Unlike lice, white piedra will not produce a severely itchy sensation or make you feel like something is crawling along your head. White piedra nodules are easy to remove while lice nits are not.

Black piedra vs. white piedra

Black piedra is a cousin to white piedra. The nodules that characterize black piedra are hard, black/brown in color, and difficult to remove. Black piedra is more commonly seen in scalp hair and not facial or body hair.

Tinea versicolor vs. white piedra

Tinea versicolor is a fungal skin infection caused by yeast. People with this condition can get scaly patches anywhere on their body. These patches can be lighter or darker than your natural skin color. Unlike these skin patches, white piedra appears as nodules around the hair shaft that are a white-to-tan in color.

Dandruff vs. white piedra

Dandruff is a condition that affects the scalp, while white piedra affects the hair shaft.

The technical cause of white piedra is a fungus of the trichosporon variety. This fungus is found mostly in soil. It is not clear how people get this infection but it may be that people who get white piedra already have the trichosporon fungus on their skin.

Doctors diagnose white piedra by examining the hair shaft and the nodules. They may also perform tests on the fungus to help pinpoint their diagnosis.

The first line of treatment is to completely shave off all infected hair. Doing so may be sufficient to rid yourself of the fungus. Other treatment options include antifungal creams, shampoos, and oral antifungal medications.

The most common complication of white piedra is hair loss and/or brittle hair. People who are immunosuppressed (who have HIV or are undergoing chemotherapy), can have pruritic (characterized by a burning sensation) or necrotic (consisting of dead tissue) nodules or papules. These can cause intense itching and discomfort.

While shaving infected hair is the first line of defense, the condition does respond well to topical and oral antifungal treatments, usually used for just a few weeks. For the most part, white piedra is a harmless condition and most people will recover with few if any health consequences. They will also go on to grow healthy hair.

Nobody enjoys an itchy scalp. Unless it is a chronic condition, lice are often the first concern when the scalp suddenly begins to itch — particularly if you or your children have been exposed to a recent outbreak at school, in day care, or during some sort of group activity (e.g. summer camp).

Because lice are extremely common and contagious, it is important to be able to distinguish between lice, nits, dandruff, and a dry scalp to prevent the unnecessary spreading of lice.

Lice vs. Dandruff & Dry Scalp

Dandruff (also known as seborrhea dermatitis) affects up to 50% of the general population. It is caused by the excessive production of dead skin cells that itch and become flaky. It is self-contained and cannot be spread to others, though some evidence does suggest dandruff can run in families. Dandruff affects those who have either overly dry or oily scalps, often resulting in scaly skin and white flaky particles visible in the hair.

Lice, on the other hand, are highly contagious parasites that look like tiny white bugs. Left untreated, they infest the scalp and cause an irritating itching sensation as they crawl around and lay eggs. Lice often spread quickly and easily because they can crawl from one infected scalp to another through head-to-head contact. In fact, 6-12 million U.S. kids between the ages of 3 and 11 become infected with lice each year.

How to Tell the Difference Between Lice & Dandruff

The quickest way to distinguish between lice and dandruff is that lice don’t just brush out; they adhere to the hair with a cement-like bonding agent and are very difficult to remove without special tools, such as a lice comb. If it brushes out or you can flick it out, it’s likely dandruff.

Note that lice are unable to jump, fly, or swim, and cannot survive in your surrounding environment (furniture, sheets, etc.).

There are three forms of lice:

1. Also known as nits, lice eggs are hard to see and often confused for dandruff or droplets of hair spray. They are small white specks and can be found at the base of the hair shaft.
2. When lice eggs hatch, they release nymphs. The shells of hatched lice eggs remain attached to the hair and present as a dull yellow color. The nymphs themselves are tiny and tan-colored, and grow into adults over the course of about a week.
3. Adult lice have six legs, each with a claw, and are tan to grayish-white in color. They are no bigger than a sesame seed. Adults multiply quickly, laying up to five eggs per day and living for up to 30 days.

Illustration and info with thanks to Centers for Disease Control and Prevention (CDC).

Lice vs. Nits

Covered above, nits (i.e. lice eggs) are typically white, tan, or brown in color and usually attach to individual strands of hair.

While adult lice only grow to about the size of a sesame seed, nits are even smaller, resembling microscopic specs in the hair. It is much easier to contain nits prior to them hatching into a full-blown lice infestation.

If you or your children have been exposed to a recent lice outbreak, it is highly advisable that you invest in a lice prevention kit. (Even if not, it is beneficial to have one on hand; you never know when an outbreak may happen.)

What Causes Lice? What Causes Dandruff?

Contrary to popular belief, lice are not associated with cleanliness. Many wrongly assume that only those who fail to wash their hair regularly intercept lice, when in reality lice can affect anyone who comes into contact with an infected individual. Several studies show that lice are most prevalent in closed environments with young children – like schools and day cares – where kids can easily experience head-to-head contact.

Unlike lice, which are highly contagious, dandruff is not infectious. The Journal of Investigative Dermatology has reported that dandruff is the result of three factors: excessive skin oil secretion, the over-production of yeast, and allergic reactions. Some studies also suggest that dandruff could be partly hereditary.

The Difference Between Lice & Dandruff Symptoms

While both conditions cause an itchy scalp, there are some key difference in lice vs. dandruff symptoms.

What lice look like:

• Moving white bugs (the size of sesame seeds or smaller)
• Tiny white, clear, tan, or brown eggs (nits) stuck to hair strands about one inch from the root
• Small white specs stuck to the scalp

What lice feel like:

• Lice create an itching sensation as a result of their movement. When you have a lice infestation, you can often feel the tiny bugs crawling around your scalp.

What dandruff looks like:

• White specs and flakes that fall easily from the hair
• Excessively oily or dry scalp
• Scaly skin on the scalp

What dandruff feels like:

• Dandruff feels like the skin of the scalp has become overly dry and flaky, resulting in an itchy feeling. You can often feel clumps of dry skin in your hair.

How to Identify Lice & Dandruff

Performing regular head checks, especially on children, can help identify any dandruff or lice before the condition spreads. Dandruff is often easily spotted as dead skin cells begin to flake away from the scalp, while lice can be a bit trickier to identify and may require a professional lice screening.

When searching for lice, it is important to examine the hair under a bright light and work in sections. Professionals will often use a lice comb to sort through the hair and remove any dandruff or debris that could be mistaken for lice. You should be looking for any nits stuck to strands of hair, or lice (small six-legged, wingless bugs) crawling through the hair or scalp. Make sure to check around the ears, nape, and hairline as these are the places lice tend to congregate most.

How to Treat Dandruff

Dandruff can often be treated at home using specially formulated shampoos and topical creams. Washing your hair regularly with products for sensitive skin and ensuring that you adequately scrub your scalp can minimize itchiness.

Several effective home remedies for dandruff include tea tree oil, eucalyptus oil, and neem oil.

Tea Tree Oil
Tea tree oil is a very popular dandruff treatment. Simply mix it with your regular shampoo (approximately 10 drops per eight ounces) and wash as usual. Alternatively, purchase a shampoo that already contains tea tree oil as an active ingredient.

Another option is to mix it with a carrier oil (such as jojoba oil) and massage it into your scalp for 10-15 minutes before washing.

Related: Tea Tree Oil for Lice Prevention

Eucalyptus Oil
Eucalyptus oil has strong antimicrobial and antifungal properties effective at combatting dandruff. It can be used in the same manner as tea tree oil.

Neem Oil
Extracted from the fruit and seeds of the neem tree, neem oil relieves dandruff and dry scalp by maintaining the scalp’s pH level.

How to Treat Lice

Unfortunately, most home remedies for lice don’t work. Should you spot lice, it is best to consult a lice professional as it is highly contagious and may need an intensive treatment plan to eliminate the infestation.

Find a Salon Near You

If you are more of a do-it-yourselfer, we have a page dedicated to getting rid of lice at home.

Questions About Lice?
Hair Fairies is always here to help! Give us a call at 877-285-0069 or contact us by e-mail.