Tinea versicolor

Malassezia yeasts are the type of fungi that cause tinea versicolor, and they normally live on the skin.

The yeast secretes azelaic acid triggering pigmented changes in the skin.

The organism is lipophilic and the findings are confined to seborrheic portions of the skin where sebum is produced.

Sebaceous glands release sebum, a fatty oily substance, through hair follicles in skin that provides nutrients necessary for the yeast to survive.

The fungus flourishes and causes tinea versa color in hot and humid climates, when there is excess sweat, or the presence of a weakened immune system.

Oral antifungal agents, or topical agents can control the process.

Pityriasis versicolor commonly causes hypopigmentation in people with dark skin tones.

Occasionally fine scaling of the skin producing a very superficial ash-like scale

Commonly affects adolescents and young adults, especially in warm and humid climates.

It can affect some families more than others.

It is not a contagious process.

Caused by yeast thought to feed on skin oils, as well as dead skin cells.

Infections are more common in people who have seborrheic dermatitis, dandruff, and hyperhidrosis.

The symptoms of this condition include:

Pale, dark tan, or pink in color, with a reddish undertone that can darken when the patient 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.

The skin appears to be lighter, darker, or rather than surrounding unaffected skin. It commonly affects the chest to back, areas with the greatest number of sebaceous glands.

TV may also involve the upper arms, neck, and face.

Commonly is found/noticed during the summer months, when the fact that area fails to tan compared with unaffected nearby tanned skin.

TV may be associated with scales or flaking on the outer layer of skin. TV usually causes no symptoms but itching may occur.

Pityriasis versicolor is more common in hot, humid climates, with sweating heavily, so it may recur each summer.

The yeasts can often be seen under the microscope within the lesions and typically have a so-called spaghetti and meatball appearance as the round yeasts produce filaments.

Scraping or or stretching the affected area to see if it causes more scale to appear: evoked scale sign, May help in diagnosis.

In people with dark skin tones, pigmentary changes such as hypopigmentation are common, while in those with lighter skin color, hyperpigmentation is more common.

In cases caused by the fungus Malassezia furfur, lightening of the skin occurs due to the fungus’s production of azelaic acid, which has a slight bleaching effect.

Diagnosed by a potassium hydroxide (KOH) preparation and lesions may fluoresce copper-orange when exposed to Wood’s lamp.

The differential diagnosis includes:

Progressive macular hypomelanosis

Pityriasis alba

Pityriasis rosea

Seborrheic dermatitis

Erythrasma

Vitiligo

Leprosy

Syphilis

Post-inflammatory hypopigmentation

Treatments include:

Topical antifungal medications containing selenium sulfide are often recommended: Ketoconazole, Ciclopirox, and other topical antifungal agents such as clotrimazole, miconazole, flucanazole, terbinafine, or zinc pyrithione can lessen symptoms.

Hydrogen peroxide has been known to lessen symptoms and, on certain occasions, remove the problem.

Oral antifungals including ketoconazole or fluconazole in a single dose, or ketoconazole for seven days, or itraconazole can be used.