Background: Topical antifungals are the most commonly used therapy in white piedra of the scalp. However, persistence and relapse of infection still pose a significant challenge. Systemic antifungals have been recommended to enhance the therapeutic response. Aims: To compare the efficacy of topical antifungal alone versus combined topical and oral antifungals in the treatment of white piedra of the scalp. Methods: Sixty patients with white piedra of the scalp were divided into 3 groups, each containing 20 patients. Group A received topical clotrimazole, group B received combined topical clotrimazole and oral itraconazole, and group C received combined topical clotrimazole and oral terbinafine. The treatment was continued until clearance of infection was confirmed by dermoscopic and mycological examination. Positive responders were followed up for 3 months after treatment. Results: All the patients achieved complete clearance of infection. The median treatment time in group B was significantly shorter than group A (P < .001) and group C (P < .001), respectively. In addition, the median treatment time in group C was significantly shorter than group A (P = .002). No recurrence of infection was noted during follow-up period. Conclusion: The three modalities were effective in the treatment of white piedra of the scalp. The most rapid response was observed with the combined use of topical and oral azoles.