Updated: 9/23/2017

Tinea Versicolor

Review Topic
  • A 15-year-old girl presents to her pediatrician’s office for a routine check-up prior to school starting. She has no complaints. She spent a summer in Hong Kong. On physical exam, her physician notices multiple faint light-colored macules and patches along her back, breasts, and abdomen. She collects some skin scraping and prepares a wet mount with potassium hydroxide. Under microscopy, she sees multibranching hyphae and budding that resembles spaghetti and meatballs.
  • Clinical definition
    • very common cutaneous fungal infection
      • characterized variably colored macules and patches
      • also known as pityriasis versicolor
  • Epidemiology
    • prevalence
      • 30-40% in tropical climates
      • 1-4% in temperate climates
    • demographics
      • most common in adolescents and young adults
    • risk factors
      • hot and humid weather
      • excessive sweating
      • immunosuppression
  • Etiology
    • Malassezia spp.
      • formerly Pityrosporum
  • Pathogenesis
    • when there is excessive heat and moisture, there may be increased growth of Malassezia spp. compared with other normal flora
  • Associated conditions
    • seborrheic dermatitis
  • Prognosis
    • often recurs
  • Symptoms
    • asymptomatic
    • inability to tan in affected areas
  • Physical exam
    • discolored macules and patches affecting the trunk, neck, and face
      • lesions have overlying fine scale
      • variable color
        • pale yellow
        • white
        • hypopigmentation
        • hyperpigmentation
        • yellowish brown
  • KOH preparation
    • skin scrapings mixed with KOH
    • short multibranching hyphae and budding cells
      • “spaghetti and meatballs” appearance
  • Wood lamp examination
    • affected areas fluoresce yellow to yellow-green
    • < 50% sensitivity
  • Vitiligo
    • affected areas also fluoresce under Wood lamp
    • lesions are depigmented
  • Pityriasis alba 
    • affected areas do not fluoresce under Wood lamp
  • Medical
    • topical treatment
      • indication
        • avoid systemic effects of oral medications
        • first-line therapy
      • drugs
        • zinc pyrithione 1% shampoo
        • selenium sulfide 2.5% shampoo
          • often also used for prophylaxis
        • ketoconazole shampoo
        • sulfur salicylic acid shampoo
        • azole creams
    • oral antifungals
      • indication
        • if disease is widespread or refractory to topical treatment
      • drugs
        • itraconazole
        • fluconazole
  • Areas of discoloration may be permanent

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