Tinea Versicolor (Pityriasis Versicolor)

  • Medical Author:
    Gary W. Cole, MD, FAAD

    Dr. Cole is board certified in dermatology. He obtained his BA degree in bacteriology, his MA degree in microbiology, and his MD at the University of California, Los Angeles. He trained in dermatology at the University of Oregon, where he completed his residency.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Tinea versicolor facts

  • Tinea versicolor is a common infection of healthy people caused by a fungus that is found on normal human skin.
  • There seems to be a genetic predisposition to develop tinea versicolor, the nature of which is poorly understood.
  • Tinea versicolor is easily identified under the microscope.
  • Treatment of tinea versicolor is usually effective, but recurrence is common.

What is tinea versicolor? What are symptoms and signs of tinea versicolor?

Tinea versicolor is a common fungal infection of the skin that often affects adolescents and young adults. The term versicolor refers to the fact that it causes the affected skin to change color and become either lighter or darker than surrounding skin. The most common areas it affects are the shoulders, back, and chest. At times, it can affect folds of skin, such as the crook of the arm, the skin under the breasts, or the groin. The face is usually spared, although sometimes children can have the face affected. There may be just a few spots or so many that it gives the appearance that the affected skin is normal while the unaffected skin around it seems to have a problem.

What causes tinea versicolor?

Tinea versicolor is caused by yeast called Malassezia furfur that normally live on the skin of most adults without causing problems. It exists in two forms, one of which can cause patches of discolored slightly scaly skin. Factors that induce the disease are poorly understood, but high humidity and immune changes may play roles. Most people with this condition are perfectly healthy.

Because the tinea versicolor fungus is part of the normal adult skin flora, this condition is not contagious. It often recurs after treatment, but usually not right away, so that treatment may need to be repeated only every year or two.

Tinea versicolor patches that are brown or reddish-brown go right away after treatment. This fungus produces a chemical, which seems to inhibit the normal production of pigment in the skin resulting in areas of lighter skin. It may take several months for overall color to even out. It always eventually does. Tinea versicolor does not leave permanent skin discoloration.

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What other conditions resemble tinea versicolor?

The following conditions are sometimes indistinguishable from tinea versicolor on simple inspection:

  • Pityriasis alba: This is a mild form of eczema (seen in young people) that produces mild, patchy lightening of the face, shoulders, or torso.
  • Vitiligo: This condition results in a permanent loss of pigment. Vitiligo is more likely to affect the skin around the eyes and lips or the knuckles and joints. Spots are porcelain white and, unlike those of tinea versicolor, are permanent without therapy.

How is tinea versicolor diagnosed?

It is relatively simple procedure to confirm this diagnosis. A drop of potassium hydroxide is applied to a small scraping of involved skin which is then examined under the microscope. The yeast forms can be seen and confirm the diagnosis.

What is the treatment for tinea versicolor?

There are many antifungal agents available to apply to the skin for the treatment of tinea versicolor. Over-the-counter (OTC) remedies include clotrimazole (Lotrimin, Mycelex) and miconazole (Lotrimin). These should be applied twice a day for 10-14 days but come in small tubes and are hard to apply to large areas. Another OTC option is selenium sulfide shampoo 1% (Selsun Blue) or 1% ketoconazole shampoo (Nizoral). Some doctors recommend applying these for 15 minutes twice a week for two to four weeks.

There are also many prescription-strength antifungal creams that can treat tinea versicolor, as well as a stronger form of selenium sulfide (2.5%) and prescription-strength ketoconazole shampoo (2%). However, these pose the same application problems as their OTC counterparts.

Oral treatment for tinea versicolor has the advantage of simplicity. Two doses of fluconazole (Diflucan) prescribed by your doctor can clear most cases of this infection. Some common medications such as alprazolam (Xanax) and montelukast (Singulair) may interact with fluconazole, so your doctor will need to know what other medications are being taken before treating tinea versicolor orally.

What is the prognosis of tinea versicolor?

As noted above, the white spots of tinea versicolor tends to linger even after successful treatment. This persistent discoloration often leads people to think that the condition is still present long after it has been eradicated. It may take months for skin color to blend and look normal, but it always does. The red or brown variety of rash, on the other hand, clears up much sooner. It is, therefore, a good idea to have the condition treated as soon as new spots appear so that any discoloration lasts as short a time as possible.

Recurrence of the rash is common, though it won't recur necessarily every year. Applying selenium sulfide or ketoconazole shampoo on affected areas once a week may slow the onset of recurrence but is cumbersome and often not worth the effort, since the condition may not come back for a long time anyway.

Can tinea versicolor be prevented?

Since the organism that causes tinea versicolor is a normal inhabitant of the skin and the disease does not affect the patient's general health, there is no widely accepted approach to prevention.

Medically reviewed by Norman Levine, MD; American Board of Dermatology

REFERENCE:

Bigby, Michael, and Hu, Stephanie W. "Pityriasis Versicolor: A Systemic Review of Interventions." Arch Dermatol. 146.10 (2010): 1132-1140.

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Reviewed on 11/4/2015
References
Medically reviewed by Norman Levine, MD; American Board of Dermatology

REFERENCE:

Bigby, Michael, and Hu, Stephanie W. "Pityriasis Versicolor: A Systemic Review of Interventions." Arch Dermatol. 146.10 (2010): 1132-1140.

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