Tinea Versicolor (TV), also known as Pityriasis Versicolor, is a benign, superficial fungal infection of the skin caused by Malassezia species, particularly M. furfur, M. obtusa, and M. slooffiae. TV typically presents at hypopigmented or hyperpigmented, coalescing scaling macules, most commonly involving the trunk and upper arms. Pink colored, atrophic and trichrome variants have been reported and can produce striking clinical presentation. It occurs most commonly during the summer months and favors areas of oily skin, such as the chest, abdomen, back, pubis, neck, and intertriginous areas. The areas may be mildly itching. There may be inflammation around the patches and plaques. The scalp and follicular papules may be present. Facial lesions may occur in infants and immunocompromised patients.
EPIDEMIOLOGY: TV is reported worldwide, but most commonly is observed in humid and warm conditions. The prevalence may be as high as 50% in tropical countries and as low as 1.1% in cold countries, such as Sweden. It tends to occur more frequently in adolescents and young adults, probably due to increase in sebum production by sebaceous glands. TV affects men and women equally and no specific ethnic predominance has been noted. It should also be noted that there may be a genetic predisposition to being susceptible to TV, and that the fungal organisms like to grow on certain types of keratin, since some patients are susceptible while others appear to be completely immune to the superficial skin infection.
DIAGNOSIS: The diagnosis is easily made on clinical presentation, having a characteristic look. Fungal organisms can be observed on scraping of the lesions, treated with KOH and observed under the microscope–demonstrating “spaghetti and meatballs” under the microscope.
TREATMENT: A variety of topical and oral antifungals have been shown to be effective in treating TV, however, the patient must be aware that without treatment it is likely to come back during periods of exposure to heat and humidity. I no longer treat patients with oral antifungals, believing the risk of most antifungal medications do not warrant the risk of exposure. I treat all of my patients now with Nizoral shampoo…having patients hop in the shower to dampen the skin, then apply a thin coat of the antifungal shampoo to the involved areas and left on overnight. I have my patients do this for 4 days in a row, then once every 2-4 weeks during the summer, due to the extreme heat here in the Las Vegas area. If most of the lesions resolve during the winter the patient may stop the treatment, but I always encourage initiation of treatment early spring to be ahead of blooming TV that is likely to occur during the summer. Again, this post is not designed to replace a clinic visit to a certified dermatologist. To read more about TV go HERE, HERE and HERE.