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Updated: Jun 6 2021

Tinea Versicolor

  • Snapshot
    • 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.
  • Introduction
    • 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
  • Presentation
    • 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
  • Studies
    • 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
  • Differential
    • Vitiligo
      • affected areas also fluoresce under Wood lamp
      • lesions are depigmented
    • Pityriasis alba
      • affected areas do not fluoresce under Wood lamp
  • Treatment
    • 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
  • Complications
    • Areas of discoloration may be permanent
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