Tinea versicolor facts
- Tinea versicolor is a common fungal skin infection affecting primarily healthy people caused by a fungus found on normal human skin.
- There seems to be a genetic predisposition to develop tinea versicolor, the nature of which is poorly understood.
- Doctor easily identify tinea versicolor by examining skin scrapings under the microscope.
- Treatment of tinea versicolor is usually effective, but recurrence is common.
What is tinea versicolor? What are tinea versicolor symptoms and signs?
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. It usually spares the face, 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?
A yeast called Malassezia causes tinea versicolor; it 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 form produces the patches of discolored slightly scaly skin called tinea versicolor. Currently, medical professionals believe 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 overtly contagious. It often recurs after treatment, but usually not right away, so that treatment may need to be repeated only every year or two.
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.
See pictures of tinea versicolor and other fungal skin infections
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 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), miconazole (Lotrimin), and ciclopirox (Ciclodan, Penlac, Loprox).
Apply these twice a day for 10-14 days. Unfortunately, these come in small tubes and are hard to apply to large areas. Sprays of clotrimazole are available and can be a more practical treatment approach. 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) a week for four weeks can be quite effective. Some common medications such as alprazolam (Xanax) and montelukast (Singulair) may interact with fluconazole, so your doctor will need to know what other medications you take before treating tinea versicolor orally. Terbinafine is not an effective treatment for this disease.
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 its eradication. 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.
Skin & Health: How Your Skin Reveals Health Problems
Medically Reviewed on 6/4/2019
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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.
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