|Other names: Tinea versicolor, dermatomycosis furfuracea, tinea flava|
|Light areas of the skin on the chest due to pityriasis|
|Specialty||Dermatology, infectious diseases|
|Symptoms||Dark or light slightly scaly marks on skin|
|Risk factors||Warm, humid environment, pregnancy, immunodeficiency|
|Diagnostic method||Usually based on appearance|
|Differential diagnosis||Vitiligo, secondary syphilis|
|Treatment||Antifungals (selenium sulfide, clotrimazole, ketoconazole)|
Pityriasis versicolor, also known as tinea versicolor, is a superficial fungal infection of the skin, characterized by either reddish-brown, dark or light, slightly scaly marks on the skin. It most commonly affects the upper arms and legs, chest, back, and neck. The marks may be discrete or merged together and there may be a mild itch.
It is caused by the yeast Malassezia, formerly known as Pityrosporum. These yeast are normally found on the human skin and become troublesome only under certain circumstances, such as a warm and humid environment. Other risk factors include pregnancy and immunodeficiency. The disease does not spread between people.
Diagnosis is usually by the appearance of the rash. The marks fluoresce yellow with a Wood's lamp. Direct microscopy may show a "spaghetti and meatballs appearance" of the spores and short filaments. Vitiligo and chloasma do not scale, but otherwise may appear similar. Treatment options include selenium sulfide shampoo, and other creams and shampoos containing antifungals such as clotrimazole 1% or ketoconazole 2%. If this is not effective antifungals by mouth may be used. While the disease is not serious, it may recur.
Pityriasis versicolo is common. Rates are as high as 50% in tropical countries. It is more common during the summer. Males and females are affected equally. The condition was first identified in 1846. Versicolor comes from the Latin, from versāre "to turn" and "color".
Signs and symptoms
Pityriasis versicolor usually presents as reddish-brown or dark or light slightly scaly well defined marks on the skin of generally the upper arms, shoulders, chest and back. The marks may be discrete or merge together and there may be a mild itch. Less likely, the condition can occur in the underarms, in the groin, on the backs of hands, or around the genitals and thighs.
The scales may appear a very superficial ash-like scale. The marks can be pale, dark tan, or pink in color, with a reddish undertone that can darken when the person is overheated, such as in a hot shower or during/after exercise. Tanning typically makes the affected areas contrast more starkly with the surrounding skin.
In people with dark skin tones, pigmentary changes such as hypopigmentation (loss of color) are common, while in those with lighter skin color, hyperpigmentation (increase in skin color) is more common. These discolorations have led to the term "sun fungus".
Pityriasis versicolor: light appearance in a person with dark skin.
Pityriasis versicolor is more common in hot, humid climates or in those who sweat heavily, so it may recur each summer.
Direct microscopy may show "spaghetti and meatballs appearance" of the spores and short filaments. Dermoscopy is useful to confirm fine scales. Culture of Malassezia from skin scrapings does not help diagnosis.
Magnified view: fine scale over dark area in pityriasis versicolor
Wood's lamp: fluorescence of pityriasis versicolor
- Progressive macular hypomelanosis
- Pityriasis alba
- Pityriasis rosea
- Seborrheic dermatitis
- Post-inflammatory hypopigmentation
Other topical antifungal medications include Ketoconazole (Nizoral ointment and shampoo). It is normally applied to dry skin and washed off after 10 minutes, repeated daily for two weeks. Ciclopirox (Ciclopirox olamine) is an alternative treatment to ketoconazole, as it suppresses growth of the yeast Malassezia furfur. Initial results show similar efficacy to ketoconazole with a relative increase in subjective symptom relief due to its inherent anti-inflammatory properties. Other topical antifungal agents such as clotrimazole, miconazole, terbinafine, or zinc pyrithione can lessen symptoms in some patients. Additionally, hydrogen peroxide has been known to lessen symptoms and, on certain occasions, remove the problem, although permanent scarring has occurred with this treatment in some sufferers. Clotrimazole is also used combined with selenium sulfide.
Oral antifungals including ketoconazole or fluconazole in a single dose, or ketoconazole for seven days, or itraconazole can be used. The single-dose regimens, or pulse therapy regimens, can be made more effective by having the patient exercise 1–2 hours after the dose, to induce sweating. The sweat is allowed to evaporate, and showering is delayed for a day, leaving a film of the medication on the skin.
This skin disease commonly affects adolescents and young adults, especially in warm and humid climates.
Males and females are affected equally.
It is also commonly referred to as Peter Elam's disease in parts of South Asia.
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