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.

Tinea versicolor facts

  • Tinea versicolor is a common fungal skin infection affecting primarily 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 by examining skin scrapings 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 frequently alters the color of involved 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 this is not always true for children. Careful examination of the affected areas will reveal a slight increase in superficial scale. The disease rarely produces any symptoms.

What causes tinea versicolor? Is tinea versicolor contagious?

Tinea versicolor is caused by yeast called Malassezia that normally lives on the skin of most adults without producing a disease. It exists in two forms, a yeast form and a form that resembles "penne and meatballs" when viewed microscopically. This second is presumed to produce the patches of discolored slightly scaly skin called tinea versicolor. Currently, it is believed that a chemical produced by Malassezia, azelaic acid, is responsible for the loss of pigment. 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 Treatment

Clotrimazole (Lotrimin, Mycelex)

Clotrimazole is an anti-fungal medication related to fluconazole (Diflucan), ketoconazole (Nizoral), itraconazole (Sporanox), and miconazole (Micatin, Monistat). It prevents growth of several types of fungi by preventing interfering with the production of the membrane that surrounds fungal cells. It is used topically on the skin, inserted vaginally or allowed to dissolve in the mouth for local fungal infections.

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 do health care professionals diagnose tinea versicolor?

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 penne-and-meatball 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) or itraconazole (Sporanox) 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.

Is it possible to prevent tinea versicolor?

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.

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Medically Reviewed on 12/4/2017
References
REFERENCES:

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

Harada, Kazutoshi, Mami Saito, Takashi Sugita, and Ryoji Tsuboi. "Malassezia Species and Their Associated Skin Diseases." Journal of Dermatology 42 (2015): 250-257.

Kallini, Joseph R., Riaz, Fauzia, and Amor Khachemoune. "Tinea Versicolor in Dark-Skinned Individuals." International Journal of Dermatology 53 (2014): 137-141.

Mendez-Tovar, Luis J. "Pathogenesis of Dermatophytosis and Tinea Versicolor." Clinics in Dermatology 28 (2010): 185-189.
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